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首页> 外文期刊>Critical care : >Recombinant activated protein C treatment improves tissue perfusion and oxygenation in septic patients measured by near-infrared spectroscopy
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Recombinant activated protein C treatment improves tissue perfusion and oxygenation in septic patients measured by near-infrared spectroscopy

机译：重组活化的C蛋白治疗可改善败血症患者的组织灌注和氧合作用，采用近红外光谱法

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IntroductionThe purpose was to test the hypothesis that muscle perfusion, oxygenation, and microvascular reactivity would improve in patients with severe sepsis or septic shock during treatment with recombinant activated protein C (rh-aPC) (n = 11) and to explore whether these parameters are related to macrohemodynamic indices, metabolic status or Sequential Organ Failure Assessment (SOFA) score. Patients with contraindications to rh-aPC were used as a control group (n = 5).Materials and methodsPatients were sedated, intubated, mechanically ventilated, and hemodynamically monitored with the PiCCO system. Tissue oxygen saturation (StO2) was measured using near-infrared spectroscopy (NIRS) during the vascular occlusion test (VOT). Baseline StO2 (StO2 baseline), rate of decrease in StO2 during VOT (StO2 downslope), and rate of increase in StO2 during the reperfusion phase were (StO2 upslope) determined. Data were collected before (T0), during (24 hours (T1a), 48 hours (T1b), 72 hours (T1c) and 96 hours (T1d)) and 6 hours after stopping rh-aPC treatment (T2) and at the same times in the controls. At every assessment, hemodynamic and metabolic parameters were registered and the SOFA score calculated.ResultsThe mean ± standard deviation Acute Physiology and Chronic Health Evaluation II score was 26.3 ± 6.6 and 28.6 ± 5.3 in rh-aPC and control groups, respectively. There were no significant differences in macrohemodynamic parameters between the groups at all the time points. In the rh-aPC group, base excess was corrected (P < 0.01) from T1a until T2, and blood lactate was significantly decreased at T1d and T2 (2.8 ± 1.3 vs. 1.9 ± 0.7 mmol/l; P < 0.05). In the control group, base excess was significantly corrected at T1a, T1b, T1c, and T2 (P < 0.05). The SOFA score was significantly lower in the rh-aPC group compared with the controls at T2 (7.9 ± 2.2 vs. 12.2 ± 3.2; P < 0.05). There were no differences between groups in StO2 baseline. StO2 downslope in the rh-aPC group decreased significantly at all the time points, and at T1b and T2 (-16.5 ± 11.8 vs. -8.1 ± 2.4%/minute) was significantly steeper than in the control group. StO2 upslope increased and was higher than in the control group at T1c, T1d and T2 (101.1 ± 62.1 vs. 54.5 ± 23.8%/minute) (P < 0.05).ConclusionsTreatment with rh-aPC may improve muscle oxygenation (StO2 baseline) and reperfusion (StO2 upslope) and, furthermore, rh-aPC treatment may increase tissue metabolism (StO2 downslope). NIRS is a simple, real-time, non-invasive technique that could be used to monitor the effects of rh-aPC therapy at microcirculatory level in septic patients.
机译：简介目的是检验以下假设，即在使用重组活化蛋白C（rh-aPC）（n = 11）治疗期间患有严重脓毒症或脓毒性休克的患者中，肌肉灌注，氧合作用和微血管反应性会改善，并探讨这些参数是否为与大血流动力学指标，代谢状态或器官功能衰竭评估（SOFA）评分有关。将有rh-aPC禁忌症的患者作为对照组（n = 5）。材料和方法用PiCCO系统对患者进行镇静，插管，机械通气和血流动力学监测。在血管闭塞试验（VOT）期间，使用近红外光谱（NIRS）测量组织氧饱和度（StO2）。确定基线StO2（StO2基线），VOT期间StO2的降低速率（StO2下坡）和再灌注阶段StO2的升高速率（StO2上坡）。在（t0）之前，期间（24小时（T1a），48小时（T1b），72小时（T1c）和96小时（T1d））和停止rh-aPC治疗（T2）之后6小时以及相同的时间收集数据控件中的时间。在每次评估中，记录血流动力学和代谢参数，并计算SOFA评分。结果rh-aPC组和对照组的急性生理和慢性健康评估II评分的平均±标准差分别为26.3±6.6和28.6±5.3。在所有时间点，各组之间的血流动力学参数无显着差异。在rh-aPC组中，从T1a到T2纠正了碱过量（P <0.01），并且在T1d和T2时血乳酸显着降低（2.8±1.3对1.9±0.7 mmol / l; P <0.05）。在对照组中，T1a，T1b，T1c和T2的碱基过量得到了明显纠正（P <0.05）。在T2时，rh-aPC组的SOFA得分明显低于对照组（7.9±2.2对12.2±3.2; P <0.05）。 StO2基线之间的组之间没有差异。 rh-aPC组的StO2下坡在所有时间点均显着下降，并且在T1b和T2（-16.5±11.8对-8.1±2.4％/分钟）明显比对照组陡。在T1c，T1d和T2时，StO2上坡增加并高于对照组（101.1±62.1 vs.54.5±23.8％/ min）（P <0.05）。结论rh-aPC的治疗可能会改善肌肉氧合作用（StO2基线）和再灌注（StO2下坡），以及rh-aPC治疗可能会增加组织代谢（StO2下坡）。 NIRS是一种简单，实时，无创的技术，可用于在脓毒症患者的微循环水平上监测rh-aPC治疗的效果。

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