通过被动腿部提升和微血管皮肤血流来预测外围组织 perfusion 液体的响应性
Alexandra Morin1, Tomas Urbina1, Juliette Bernier1
1Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, APHP, Paris, France.
Critical care (London, England)
|January 22, 2026
概括
通过监测皮肤血流 (SBF),被动腿抬起 (PLR) 有效地预测了败血症患者的液体反应能力. 这种非侵入性方法有助于指导个性化流体策略,以获得最佳的组织 perfusion.
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
- 微循环是一种微循环.
背景情况:
- 败血症患者经常表现出复杂的液体反应能力.
- 精确预测液体反应对于优化血动力学和血症中的组织输液至关重要.
- 目前用于评估流体反应的方法可能是侵入性的或缺乏微血管评估的精度.
研究的目的:
- 为了评估皮肤血流 (SBF) 在被动腿部提升 (PLR) 期间的监测是否可以预测败血症患者的液体反应.
- 确定由PLR诱导的SBF变化的可靠性,以评估微血管对液体的反应.
主要方法:
- 在医疗重症监护病房进行前性观察性研究.
- 成年败血症患者接受了标准化的PLR操作,随后给予500毫升盐水.
- 使用指尖激光多普勒流量计,持续监测外围SBF.
主要成果:
- 73%的患者是流体反应者,定义为SBF体积后扩张>15%的增加.
- 受访者在PLR期间显示出显著的SBF增加 (40%),与非受访者不同.
- 由PLR诱导的SBF变化 (ΔSBF-PLR) 准确地预测了流体响应 (AUROC 0.95),超过6%的值显示出高灵敏度 (96%) 和特异性 (90%).
结论:
- 由PLR诱导的SBF变化可靠地预测了败血症患者的微血管液体反应能力.
- 这种简单的,非侵入性的技术为个性化流体管理提供了一种实用的方法.
- 在重症患者中,优化微血管组织输液可以通过这种方法来促进.
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