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败血症中的临界关闭和组织 perfusion 压力-风险分层的影响:回顾性队列研究

Jing-Yi Wang^1,2,3,4, Shi-Tong Diao^1,3,4, Tian-Yuan Zhu^1,3,4

¹Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.

|December 5, 2025

概括

临界关闭压力 (Pcc) 和组织 perfusion 压力 (TPP) 在败血症中提供了超出平均动脉压力 (MAP) 的宝贵预后见解. 这些参数可以改善风险分层,并指导重症患者的血压管理.

科学领域:

关键护理医学关键护理医学
血液动力学血液动力学
败血症的病理生理学

背景情况:

在败血症管理中,最优的平均动脉压 (MAP) 目标受到辩论.
临界关闭压力 (Pcc) 和组织 perfusion 压力 (TPP) 是影响组织 perfusion 的关键血液动力学参数.
评估Pcc和TPP的预后效用可以提高败血症风险分层.

研究的目的:

评估患有败血症的患者中Pcc和TPP的预后价值.
为了确定Pcc和TPP是否与单独的MAP相比改善了风险分层.
调查Pcc和TPP与败血症中死亡率和急性损伤 (AKI) 的关联.

主要方法:

在18家医院对6769名成人败血症患者进行了回顾性队列研究.
通过线性回归估计Pcc;TPP计算为MAP减去Pcc.
患者根据Pcc和TPP值分为四组;分析结果包括死亡率和AKI;使用MIMIC-IV队列进行外部验证.

主要成果:

低TPP-低Pcc组 (35.1%) 的ICU死亡率明显高于高TPP-高Pcc组 (20.1%).
在增加的Pcc和减少的TPP之间观察到U形的关联,死亡率和AKI率更高 (P<0.001).
在独立数据集和外部验证队列中,研究结果一致.

结论:

在败血症管理中,Pcc和TPP为MAP提供了补充的预后信息.
将Pcc和TPP纳入临床评估可能会增加风险分层.
在败血症中优化血压管理可能受益于考虑Pcc和TPP.

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