败血症患儿舌下微循环的特点及临床价值

中国小儿急救医学 Pub Date : 2020-03-20 DOI:10.3760/CMA.J.ISSN.1673-4912.2020.03.009

Meng Wang

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In the sepsis group, large circulation indexes and sublingual microcirculation indexes were collected at 0, 6, and 24 hours after admission.Sublingual microcirculation indexes were collected by bypass dark field imaging.In the control group, large circulation indexes were collected after admission, and sublingual microcirculation indexes were collected during tracheal endoscopic examination after sedation.De Backer score(DBs), hetergeneity index(HI), hetergeneity index small(HIs), proportion of pefusedvessels(PPV), proportion of pefused small vessels(PPVs), total of vessel density(TVD), pefused vessel density(PVD), pefused small vessel density(PVDs)were selected as the evaluation index of sublingual microcirculation.The changes of macrocirculation and microcirculation indexes in the two groups were compared, and the correlation between age and microcirculation indexes in the control group was analyzed. \n \n \nResults \nA total of 71 children, including 10 sepsis cases and 61 CAP cases, were collected.Among the 61 children with CAP, 9 children (2-48 months) in the same age range as the sepsis group were divided into control group A, and the indicators between the two groups were analyzed.Compared with control group A, PPV and PPVs were lower and DBs, HI, HIs, TVD were higher in the sepsis group at 0 hours(P 0.05). At 24 hours, HI, PPV and PPVs improved, no difference was found compared with the control group A(P 0.05). 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引用次数: 0

摘要

目的探讨儿童败血症舌下微循环的特点，探讨舌下微循环在儿童败血症早期诊断、疗效评价中的临床价值。方法将我院2018年12月至2019年12月收治的败血症和社区获得性肺炎患儿分为败血症组和对照组（CAP组）。脓毒症组在入院后0、6和24小时采集大循环指数和舌下微循环指数。采用旁路暗场成像法采集舌下微循环指标。对照组入院后采集大循环指标，镇静后气管内窥镜检查时采集舌下微循环指标。选择De Backer评分（DB）、混杂指数（HI）、小混杂指数（HIs）、毛细血管比例（PPV）、小血管比例（PPVs）、总血管密度（TVD）、血管密度（PVD）和小血管密度（PVDs）作为舌下微循环的评价指标。比较两组大鼠微循环及微循环指标的变化，分析对照组大鼠年龄与微循环指标的相关性。结果共收集儿童71例，其中败血症10例，CAP 61例。在61名CAP患儿中，将与败血症组年龄段相同的9名患儿（2-48个月）分为对照组A，并分析两组之间的指标。与对照组A相比，败血症组0小时PPV和PPV较低，DBs、HI、HIs、TVD较高（P＜0.05）。24小时HI、PPV和PPS改善，与对照组相比无差异（P＞0.05）。对照组年龄与HI呈中度负相关，与HIs呈弱负相关（r=-0.420，P=0.001；r=-0.387，P=0.002）。结论HI、HIs、PPV和PPV是败血症患儿微循环障碍的敏感指标。液体复苏治疗可改善脓毒症患儿舌下微循环指标，但脓毒症儿童舌下微循环的改善晚于大循环的恢复。CAP患儿HI和HI与月龄呈负相关。关键词：败血症；舌下微循环；侧流暗场；社区获得性肺炎；儿童

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Characteristics and clinical value of sublingual microcirculation in children with sepsis

Objective To investigate the characteristics of sublingual microcirculation in children with sepsis, and to explore the clinical value of sublingual microcirculation in the early diagnosis, therapeutic effect evaluation of sepsis in children. Methods Children with sepsis and community acquired pneumonia(CAP) admitted in our hospital from December 2018 to December 2019 were included in the study, which was divided into sepsis group and control group(CAP group). In the sepsis group, large circulation indexes and sublingual microcirculation indexes were collected at 0, 6, and 24 hours after admission.Sublingual microcirculation indexes were collected by bypass dark field imaging.In the control group, large circulation indexes were collected after admission, and sublingual microcirculation indexes were collected during tracheal endoscopic examination after sedation.De Backer score(DBs), hetergeneity index(HI), hetergeneity index small(HIs), proportion of pefusedvessels(PPV), proportion of pefused small vessels(PPVs), total of vessel density(TVD), pefused vessel density(PVD), pefused small vessel density(PVDs)were selected as the evaluation index of sublingual microcirculation.The changes of macrocirculation and microcirculation indexes in the two groups were compared, and the correlation between age and microcirculation indexes in the control group was analyzed. Results A total of 71 children, including 10 sepsis cases and 61 CAP cases, were collected.Among the 61 children with CAP, 9 children (2-48 months) in the same age range as the sepsis group were divided into control group A, and the indicators between the two groups were analyzed.Compared with control group A, PPV and PPVs were lower and DBs, HI, HIs, TVD were higher in the sepsis group at 0 hours(P 0.05). At 24 hours, HI, PPV and PPVs improved, no difference was found compared with the control group A(P 0.05). The age of the control group had a moderate negative correlation with HI, and a weak negative correlation with HIs(r=-0.420, P=0.001; r=-0.387, P=0.002). Conclusion HI, HIs, PPV and PPVs are sensitive indexes of microcirculation disorder in children with sepsis.Fluid resuscitation therapy can improve the indexes of sublingual microcirculation in children with sepsis, but the improvement of sublingual microcirculation in children with sepsis is later than the recovery of macro circulation.HI and HIs are negatively correlated with month age in children with CAP. Key words: Sepsis; Sublingual microcirculation; Sidestream dark field; Community acquired pneumonia; Children

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来源期刊

中国小儿急救医学

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6226

期刊介绍： Chinese Journal of Neurology was established in 1955, the predecessor of which is Chinese Journal of Neurology and Psychiatry. Chinese Journal of Neurology and Psychiatry has been indexed by MEDLINE until 1996, when it was divided into two journals, Chinese Journal of Neurology, and Chinese Journal of Psychiatry. Chinese Journal of Neurology is now indexed by EM, SCOPUS, AJ, WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 2.755 in 2017, ranking the first among all neurological and psychological journals in China and among all the 142 medical journals published by the Chinese Medical Association. The journal is available both in print and online.