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早期外周灌注监测在感染性休克中的应用。

Early peripheral perfusion monitoring in septic shock.

机构信息

Department of Critical Care Medicine, Peking Union Medical College & Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, 100730, China.

出版信息

Eur J Med Res. 2024 Sep 30;29(1):477. doi: 10.1186/s40001-024-02074-1.

Abstract

Septic shock is a frequent critical clinical condition and a leading cause of death in critically ill individuals. However, it is challenging to identify affected patients early. In this article, we discuss new perspectives on the methods and uses of peripheral perfusion monitoring, considering the concept of a dysregulated response. Physical examination, and visual and ultrasonographic techniques are used to measure peripheral microcirculatory blood flow to reflect tissue perfusion. Compared with other monitoring techniques, peripheral perfusion monitoring has the benefits of low invasiveness and good repeatability, and allows for quick therapeutic judgments, which have significant practical relevance. Peripheral perfusion monitoring is an effective tool to detect early signs of septic shock, autonomic dysfunction, and organ damage. This method can also be used to evaluate treatment effectiveness, direct fluid resuscitation and the use of vasoactive medications, and monitor vascular reactivity, microcirculatory disorders, and endothelial cell damage. Recent introductions of novel peripheral perfusion monitoring methods, new knowledge of peripheral perfusion kinetics, and multimodal peripheral perfusion evaluation methods have occurred. To investigate new knowledge and therapeutic implications, we examined the methodological attributes and mechanisms of peripheral perfusion monitoring, in this study.

摘要

脓毒症休克是一种常见的危急重症临床情况,也是危重症患者死亡的主要原因。然而,早期识别受影响的患者具有挑战性。在本文中,我们讨论了外周灌注监测方法和用途的新观点,考虑了失调反应的概念。体格检查、视觉和超声技术用于测量外周微循环血流以反映组织灌注。与其他监测技术相比,外周灌注监测具有微创性和良好的可重复性的优点,并允许快速进行治疗判断,这具有重要的实际意义。外周灌注监测是检测脓毒症休克、自主神经功能障碍和器官损伤早期迹象的有效工具。该方法还可用于评估治疗效果、指导液体复苏和血管活性药物的使用,并监测血管反应性、微循环障碍和内皮细胞损伤。最近出现了新型外周灌注监测方法、外周灌注动力学的新知识以及多模态外周灌注评估方法。为了研究新的知识和治疗意义,我们在这项研究中检查了外周灌注监测的方法学属性和机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6f95/11440805/748aeedc0df5/40001_2024_2074_Fig1_HTML.jpg

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