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目的应用旁流暗视野仪观察前列腺素E_1(PGE_1)对严重脓毒症和脓毒性休克患者微循环的影响。方法采用数字表法将符合入选标准的严重感染患者34例遵照SSC 2012指南,早期目标导向复苏后,在常规“集束化”治疗的基础上,随机分为常规治疗组和PGE_1组,各17例。应用旁流暗视野技术观察患者治疗前后舌下微循环的变化。观察指标包括:总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)和微血管流动指数(MFI)。同时观察治疗前后宏循环指标的变化,记录2组APACHEⅡ评分和28 d病死率。结果 PGE_1组患者舌下微循环在给药后第1天PPV较入组时明显增加(77.21±2.72vs 75.5±7.67,P<0.05);治疗第7天,PPV、MFI较常规治疗组增加明显(86.60±6.74 vs 80.20±8.55,2.51±0.45 vs 2.19±0.46,P均<0.05)。心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、乳酸和中心静脉氧饱和度(Scv O2)及28 d死亡率在2组间比较差异均无统计学意义(P>0.05)。结论 PGE_1可改善老年严重脓毒症和脓毒性休克患者舌下微循环状况。舌下微循环指标可作为评估及指导严重脓毒症和脓毒性休克患者优化血流动力学治疗的重要方法,临床仍需更多的研究支持。
Objective To observe the effects of prostaglandin E_1 (PGE_1) on the microcirculation in patients with severe sepsis and septic shock by using the bypass flow dark-field instrument. Methods According to the guidelines of SSC 2012, 34 patients with severe infection that met the inclusion criteria were randomly divided into routine treatment group and PGE_1 group on the basis of conventional “cluster” treatment according to SSC guideline. 17 cases. Application of bypass dark field technology to observe changes in patients with sublingual microcirculation before and after treatment. Observations included TVD, PVD, PPV, and MFI. At the same time, the change of macrocycle index before and after treatment was observed. Two groups of APACHEⅡscore and 28-day mortality were recorded. Results The sublingual microcirculation in PGE_1 group was significantly increased on the first day after administration (77.21 ± 2.72 vs 75.5 ± 7.67, P <0.05). On the seventh day after treatment, PPV and MFI increased significantly compared with the conventional treatment group (86.60 ± 6.74 vs 80.20 ± 8.55, 2.51 ± 0.45 vs 2.19 ± 0.46, P <0.05). There was no significant difference in heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), lactate and central venous oxygen saturation (Scv O2) and 28 d mortality between the two groups (P> 0.05 ). Conclusions PGE 1 can improve the sublingual microcirculation in elderly patients with severe sepsis and septic shock. Sublingual microcirculation index can be used as an important method to evaluate and guide the optimization of hemodynamic therapy in patients with severe sepsis and septic shock, the clinical still need more research support.