摘要
Background： Measurement of general microcirculation remains difficult in septic shock patients. The peripheral perfusion index （PI） and sublingual microcirculation monitoring are thought to be possible methods. This study was pertbrmed to determine whether assessing microcirculation by PI and a new parameter, proportion of perfusion vessel change rate （APPV） from sublingual microcirculation monitoring, can be associated with patients＇ outcome. Methods： A prospective observational study was carried out, including 74 patients with septic shock in a mixed intensive care unit. Systemic hemodynamic variables were obtained at TO and 6 h after （T6）. PI and sublingual microcirculation indicators were obtained using a bedside monitor and a sidestream dark-field device, respectively. The t-test, analysis of variance, Mann-Whitney U-test, Kruskal- Wallis test, receiver operating characteristic curve analysis with the Hanley-McNeil test, survival curves using the Kaplan-Meier method, and the log-rank （Mantel-Cox） test were used to statistical analysis. Results： Systemic hemodynamics and microcirculation data were obtained and analyzed. Patients were divided into two groups based on whether the first 6 h lactate clearance （LC） was 〉20%; PI and APPV were lower at T6 in the LC 〈20% group compared with LC ≥20% （PI： 1.52 [0.89, 1.98] vs. 0.79 [0.44, 1,81], Z = -2.514, P - 0.012; APPV： 5.9 ±15.2 vs. 17.9 ± 20.0, t = -2.914, P = 0.005）. The cutoff values of PI and APPV were 1.41% and l 2.1%, respectively. The cutoff value of the combined indicators was 1.379 according to logistic regression. Area under the curve demonstrated 0.709 （P 〈 0.05）, and the sensitivity and specificity of using combined indicators were 0.622 and 0.757, respectively. Based on the PI and APPV cutoff; all the participants were divided into the following groups： （1） high PI and high APPV group, （2） high PI and low APPV group, （3） low PI and high zXPPV group, and （4） low PI and low APPV group. The highest Sequential Organ Failure Assessment score （14.5 ± 2.9） was in the low P1 and low APPV group （F = 13.7, P 〈 0.001）. Post hoc tests showed significant differences in 28-day survival rates among these four groups （log rank [Mantel-Cox], 20.931 ; P 〈 0.05）. Conclusion： Pl and APPV in septic shock patients are related to 6 h LC, and combining these two parameters to assess microcirculation can predict organ dysfunction and 28-day mortality in patients with septic shock.
Background： Measurement of general microcirculation remains difficult in septic shock patients. The peripheral perfusion index （PI） and sublingual microcirculation monitoring are thought to be possible methods. This study was pertbrmed to determine whether assessing microcirculation by PI and a new parameter, proportion of perfusion vessel change rate （APPV） from sublingual microcirculation monitoring, can be associated with patients＇ outcome. Methods： A prospective observational study was carried out, including 74 patients with septic shock in a mixed intensive care unit. Systemic hemodynamic variables were obtained at TO and 6 h after （T6）. PI and sublingual microcirculation indicators were obtained using a bedside monitor and a sidestream dark-field device, respectively. The t-test, analysis of variance, Mann-Whitney U-test, Kruskal- Wallis test, receiver operating characteristic curve analysis with the Hanley-McNeil test, survival curves using the Kaplan-Meier method, and the log-rank （Mantel-Cox） test were used to statistical analysis. Results： Systemic hemodynamics and microcirculation data were obtained and analyzed. Patients were divided into two groups based on whether the first 6 h lactate clearance （LC） was 〉20%; PI and APPV were lower at T6 in the LC 〈20% group compared with LC ≥20% （PI： 1.52 [0.89, 1.98] vs. 0.79 [0.44, 1,81], Z = -2.514, P - 0.012; APPV： 5.9 ±15.2 vs. 17.9 ± 20.0, t = -2.914, P = 0.005）. The cutoff values of PI and APPV were 1.41% and l 2.1%, respectively. The cutoff value of the combined indicators was 1.379 according to logistic regression. Area under the curve demonstrated 0.709 （P 〈 0.05）, and the sensitivity and specificity of using combined indicators were 0.622 and 0.757, respectively. Based on the PI and APPV cutoff; all the participants were divided into the following groups： （1） high PI and high APPV group, （2） high PI and low APPV group, （3） low PI and high zXPPV group, and （4） low PI and low APPV group. The highest Sequential Organ Failure Assessment score （14.5 ± 2.9） was in the low P1 and low APPV group （F = 13.7, P 〈 0.001）. Post hoc tests showed significant differences in 28-day survival rates among these four groups （log rank [Mantel-Cox], 20.931 ; P 〈 0.05）. Conclusion： Pl and APPV in septic shock patients are related to 6 h LC, and combining these two parameters to assess microcirculation can predict organ dysfunction and 28-day mortality in patients with septic shock.
基金
This study was supported by a grant from the National Natural Science Foundation of China （No. 81671878）.
