微循环,内皮和葡萄糖的变化与使用milrinone在患有败血性休克的儿童中相关
Mauricio Sarta-Mantilla1,2, Jaime Fernández-Sarmiento1,3, Lorena Acevedo1,3
1Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
Translational pediatrics
|June 6, 2024
概括
米利诺通过保持毛细血管密度和减少内皮糖体衰减,改善了患有败血症的儿童的微循环. 这些对微循环的有益影响在年幼的儿童中更为明显,尽管有炎症反应.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 血液动力学 血液动力学
- 败血栓冲击管理管理
背景情况:
- 传统的败血性休克治疗侧重于大循环 (血压,心脏输出).
- 持续的微循环异常 (血液动力学不一致) 尽管有足够的宏循环,但与器官功能障碍和死亡率的增加有关.
- 评估微循环和内皮糖的变化对于优化败血栓冲击管理至关重要.
研究的目的:
- 评估用milrinone治疗的感染性休克儿童的微循环 (流量,毛细血管密度) 和内皮葡萄糖体变化.
- 研究这些微循环变化与临床变量,器官功能障碍和结果之间的关系.
- 为了比较milrinone在不同年龄段的微循环效应.
主要方法:
- 在大学医院进行前性队列研究 (2022年2月 - 2023年1月).
- 语言下视频显微镜用于评估毛细血管密度,微血管流量和透边界区域 (PBR) 作为葡萄糖厚度的标志物.
- 主要结局:微循环/内皮糖变化与milrinone使用之间的关联.
主要成果:
- 其中包括140名儿童,57.9%接受了milrinone.
- 接收米利诺尼的患者在24小时内保持了功能性毛细血管密度和毛细血管招募能力.
- 两岁以下的儿童接受米利诺的治疗,即使费里含量升高,毛细血管密度也得到改善,糖核的降解也减少.
- 较高的PBR水平与死亡率相关;长时间的毛细血管补充和乳酸升高与微循环变化有关.
结论:
- 在儿科败血症休克中使用米利诺与改善的微循环参数有关.
- 保持了功能性毛细血管密度和毛细血管招募能力,在milrinone后减少了内皮质糖核体的降解.
- 这些微循环效益在较小的儿童 (<2岁) 中更为显著,并且尽管有炎症,但仍然存在.
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