舌下微循环监测对脓毒症休克患者并发急性肾损伤的预测价值

目的探讨舌下微循环监测对脓毒症休克患者并发急性肾损伤（AKI）的预测价值。 方法采用前瞻性研究方法，选择2020年5月至2021年5月我院重症医学科连续收治的55例脓毒症休克患者，使用旁流暗视野成像技术（SDF）观察其0、6、24 h舌下微循环图像，根据是否并发AKI分为AKI组（29例）和非AKI组（26例）。比较2组间体循环指标包括心率（HR）、平均动脉压（MAP）、中心静脉压（CVP），以及舌下微循环指标包括乳酸（Lac）、中心静脉血氧饱和度（ScvO₂）、小血管总密度（TVDs）、灌注小血管密度（PVDs）、小血管灌注比例（PPVs）、变异指数（HI）的变化，采用多因素二元logistic回归分析脓毒症休克并发AKI的危险因素；通过受试者工作特征曲线（ROC）的曲线下面积（AUC）评价舌下微循环指标对脓毒症休克患者并发AKI的预测价值。 结果在0、6、24 h，与非AKI组相比，AKI组Lac、HI均明显高于非AKI组，PPVs低于非AKI组，差异均有统计学意义（P均＜0.05）。多因素logistic回归分析显示，在0 h HI、PPVs是脓毒症休克患者并发AKI的独立危险因素（P＜0.05）。ROC曲线分析显示，以HI=0.8为临界值时，其预测脓毒症休克患者并发AKI的敏感度为86.21%，特异度为96.15%，AUC为0.917（95%CI：0.811~0.974，P＜0.001），以PPVs=81.2%为临界值时，敏感度为72.42%，特异度为96.15%，AUC为0.902（95%CI：0.791~0.966，P＜0.001），HI联合PPVs预测脓毒症休克患者并发AKI的AUC为0.928（95%CI：0.827~0.981，P＜0.001）。 结论舌下微循环指标HI联合PPVs对于脓毒症休克患者并发AKI的早期预测有一定的临床参考意义。

Significance of sublingual microcirculation monitoring in the early prediction evaluation for acute renal injury in patients with septic shock

ObjectiveTo explore the significance of sublingual microcirculation monitoring in the early prediction evaluation for acute renal injury in patients with septic shock. MethodsThe sublingual microcirculation images of adult patients with septic shock were observed by sidestream dark field imaging (SDF) at 0 h, 6 h and 24 h. These patients were divided into AKI group (29 cases) and non AKI group (26 cases) according to whether they developed acute renal injury (AKI); the changes of systemic circulation indexes including heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) and sublingual microcirculation indexes including Lac, ScvO₂, TVDs, PVDs, PPVs and HI were compared between the two groups. Multivariate binary logistic regression was used to analyze the risk factors of septic shock complicated with AKI; the predictive value of sublingual microcirculation index for AKI in patients with septic shock was evaluated by receiver operating characteristic curve (ROC). ResultsAt 0 h, 6 h and 24 h, compared with non-AKI group, lactate (Lac) and hetergeneity index (HI) in AKI group were significantly higher than those in non AKI group, and the proportion of perfused small vessels (PPVs) was lower than that in non AKI group (P＜0.05). Multivariate logistic regression analysis showed that at 0 h HI and PPVs were independent risk factors for AKI in patients with septic shock (P＜0.05). The ROC curve analysis showed that when HI 0.8 was used as the diagnostic cut-off point, the sensitivity of predicting AKI in patients with septic shock was 86.21%, and the specificity was 96.15 %, AUC was 0.917 (95%CI: 0.811-0.974, P＜0.001), when PPVs=81.2% was the diagnostic cut-off point, the sensitivity was 72.42%, the specificity was 96.15%, and the AUC was 0.902 (95%CI: 0.791-0.966, P＜0.001), the AUC of HI combined with PPVs for predicting AKI in patients with septic shock was 0.928 (95%CI: 0.827-0.981, P＜0.001). ConclusionSublingual microcirculation index HI combined with PPVs has a clinical significance for the early prediction of AKI in patients with septic shock.