Flick Moritz, Jannsen Gyde P, Krause Linda, Montomoli Jonathan, Pollok Franziska, Moll-Khosrawi Parisa, Kouz Karim, Bergholz Alina, Thomsen Kristen K, Hilty Matthias P, Ince Can, Zöllner Christian, Saugel Bernd
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Can J Anaesth. 2025 May;72(5):768-779. doi: 10.1007/s12630-025-02941-3. Epub 2025 May 12.
It remains unknown whether the sublingual microcirculation is impaired during noncardiac surgery. We, therefore, aimed to investigate the sublingual microcirculation in patients undergoing major abdominal surgery. Specifically, we sought to test the primary hypothesis that the sublingual microcirculation is persistently impaired during major abdominal surgery.
In this prospective observational study, we assessed the sublingual microcirculation using vital microscopy before induction of general anesthesia, at the time of surgical incision, every 20 min during surgery, and on the first postoperative day in 46 patients undergoing major abdominal surgery. The primary endpoint was the area under a proportion of perfused vessels (PPV) of 92% as a measure of the duration and severity of capillary red blood cell flow impairment.
The median [interquartile range (IQR)] intraoperative area under a PPV of 92% was 71%⋅min [2%⋅min-278%⋅min], and the median [IQR] time-weighted average PPV < 92% was 0.3% [0%-0.9%]. Twelve patients (26%) had an area under a PPV of 92% of 0%⋅min, and five patients (11%) had an area under a PPV of 92% of 400%⋅min or higher. The duration of surgery had no clinically important persistent effect on intraoperative PPV or any other sublingual microcirculation variable. The lowest intraoperative PPV was lower than the PPV at incision (estimated difference, -5.3%; 95% confidence interval, -6.3 to -4.4; P < 0.001).
The area under a PPV of 92% during elective major abdominal surgery was small, indicative of little impairment of sublingual microcirculation. The duration of surgery had no clinically important effect on sublingual microcirculatory variables.
非心脏手术期间舌下微循环是否受损尚不清楚。因此，我们旨在研究接受腹部大手术患者的舌下微循环。具体而言，我们试图验证主要假设，即腹部大手术期间舌下微循环持续受损。
在这项前瞻性观察研究中，我们对46例接受腹部大手术的患者在全身麻醉诱导前、手术切口时、手术期间每20分钟以及术后第一天使用活体显微镜评估舌下微循环。主要终点是灌注血管比例（PPV）为92%时的曲线下面积，作为毛细血管红细胞血流受损持续时间和严重程度的指标。
术中PPV为92%时曲线下面积的中位数[四分位间距（IQR）]为71%·分钟[2%·分钟 - 278%·分钟]，时间加权平均PPV < 92%的中位数[IQR]为0.3%[0% - 0.9%]。12例患者（26%）的PPV为92%时曲线下面积为0%·分钟，5例患者（11%）的PPV为92%时曲线下面积为400%·分钟或更高。手术持续时间对术中PPV或任何其他舌下微循环变量无临床重要的持续影响。术中最低PPV低于切口时的PPV（估计差异为 - 5.3%；95%置信区间为 - 6.3至 - 4.4；P < 0.001）。
择期腹部大手术期间PPV为92%时的曲线下面积较小，表明舌下微循环受损程度较轻。手术持续时间对舌下微循环变量无临床重要影响。
