丙泊酚对脓毒性休克患者舌下微循环的影响
投稿时间:2015-02-16  修订日期:2015-03-06  点此下载全文
引用本文:刘景峰,王海曼,齐志丽,段美丽.丙泊酚对脓毒性休克患者舌下微循环的影响[J].医学研究杂志,2015,44(10):57-59
DOI: 10.11969/j.issn.1673-548X.2015.10.016
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作者单位E-mail
刘景峰 100050 首都医科大学附属北京友谊医院重症医学科  
王海曼 100050 首都医科大学附属北京友谊医院重症医学科  
齐志丽 100050 首都医科大学附属北京友谊医院重症医学科  
段美丽 100050 首都医科大学附属北京友谊医院重症医学科 beauty9659@hotmail.com 
基金项目:首都医学发展基金资助项目(SF-2009-Ⅱ-14)
中文摘要:目的 探讨丙泊酚对脓毒性休克患者舌下微循环的影响。 方法 选取需要机械通气的脓毒性休克患者30例,所有患者依据病情给予经口气管插管并接呼吸机辅助通气治疗。在接受机械通气前及应用丙泊酚镇静后监测患者舌下微循环参数。同时记录患者血流动力学及氧代谢指标进行比较。 结果 所有脓毒性休克患者镇静目标达到Ramsay评分3~4分时平均丙泊酚应用剂量为1.2mg/(kg·h)。镇静后微循环指标出现不同程度改变, 总血管密度TVD(P>0.05)无明显改变;灌注血管密度 PVD(P<0.05)、灌注血管比例PPV(P<0.05)及微血管流动指数MFI(P<0.05)较镇静前下降明显。镇静后去甲肾上腺素泵入剂量较镇静前轻度增加,血流动力学参数CI及MAP较镇静前亦有轻度下降,但二者相比差值无统计学意义(P>0.05)。反应组织灌注指标血乳酸(LAC)及氧代谢指标中心静脉氧饱和度(SvO2)在镇静后升高(P<0.05)。 结论 脓毒性休克患者应用丙泊酚镇静可以使微循环及氧利用障碍加重。
中文关键词:丙泊酚  脓毒性休克  舌下微循环
 
Effect of Propofol on Sublingual Microcirculation in Patients with Septic Shock
Abstract:Objective To discuss the changes of sublingual microcirculation in patients with septic shock before and after the application of propofol sedation. Methods In total, 30 septic shock patients were enrolled in the study and all patients accepted intratracheal intubation and mechanical ventilation due to their conditions. Sublingual microcirculation parameters, hemodynamic parameters and oxygen metabolism indicators were recorded before and after the application of propofol dedation. Results All patients with septic shock achieve Ramsay score 3 to 4 points, and propofol dose was 1.2mg/(kg·h) on average. The microcirculation index appeared different degree of change afer the application of propofol. There was no obvious change of total vessel density(TVD)(P>0.05),but there was significant decrease in the perfused vessel density (PVD), proportion of perfused vessels (PPV) and microvascular flow index (MFI) (P<0.05). Inorder to keep the hemodynamic stable,norepinephrine dose was increased mildly,cardiac index (CI) and mean arterial pressure (MAP) showed a downward trend, but these changes were of no significant (P>0.05). Tissue perfusion index such as blood lactic acid (LAC) and oxygen metabolism index such as central venous oxygen saturation (SvO2) increased significantly (P<0.05) after the application of propofol. Conclusion Propofol may aggravate the sublingual microcirculation and oxygen metabolism in patients with septic shock.
keywords:Propofol  Septic shock  Sublingual microcirculation
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