Arnaldo Dubin. Critical Care 2009, 13:R92
《2008年严重脓毒症与脓 毒症休克治疗国际指南》
NE 为纠正脓毒症休克低血压首选的一线血 管升压药, 管升压药 1C级, 级 无在脓毒症治疗中选择何种儿茶酚胺类药 物的最终建议
• The effects of dobutamine on microcirculatory alterations in • patients with septic shock are independent of its systemic effects
不同液体复苏条件下多巴酚丁胺对肠缺血再灌注休克的疗效比较
涂自智 孙庆华 Geo rge D imopou lo s SuzanaM Lobo Dan ielDe
Figure 1
Changes of arter ial lactate concentration in each group
不同液体复苏条件下多巴酚丁胺对肠缺血再灌注休 克的疗效比较
Shaman Jhanji, Crit Care Med 2009 Vol. 37, No. 6
方法
• • • • N=16 cardiac output cutaneous tissue PtO2 using a Clark electrode cutaneous red blood cell flux using laser Doppler flowmetry, • Sublingual microvascular flow using sidestream darkfield imaging.
Shaman Jhanji, Crit Care Med 2009 Vol. 37, No. 6
Shaman Jhanji, Crit Care Med 2009 Vol. 37, No. 6
Shaman Jhanji, Crit Care Med 2009 Vol. 37, No. 6
Shaman Jhanji, Crit Care Med 2009 Vol. 37, No. 6
微血管构型及其微细结构
微循环障碍的监测
• • • • 血乳酸 SVO2 BE DO2，VO2
near-infrared spectroscopy (NIRS),
Creteur.Curr Opin Crit Care. 2008 Jun;14(3):361-6.
Daniel De Backer,Crit Care Med 2006 Vol. 34, No. 2
Daniel De Backer,Crit Care Med 2006 Vol. 34, No. 2
Daniel De Backer,Crit Care Med 2006 Vol. 34, No. 2
危重病与微循环
佛山市中医院 ＩＣＵ 张斌
• Krogh A．(1929)《毛细血管的解剖和生理》 》 (The Anatomy and Physiology of Capillaries) “毛细血管是血液和组织间物质交换的器 官”(…an organ for interchange Of substances be—tween the blood and the tissues：the capillaries)
涂自智 孙庆华 Geo rge D imopou lo s SuzanaM Lobo Dan ielDe Ch in Crit CareM ed, Feb. 2005,Vo l. 17,No12
Figure 3
Changes of intestinal intramucosal pH in each group
贝时璋教授： 贝时璋教授： 什么是生命活动?根据生物物理学的观 什么是生命活动 根据生物物理学的观 无非是自然界三个量综合运动的表现， 点，无非是自然界三个量综合运动的表现， 即物质、 即物质、能量和信息在生命系统中无时无 刻地在变化，这三个量有组织、有秩序的 刻地在变化，这三个量有组织、 活动是生命的基础。 活动是生命的基础。
PtCO2
• 加热的氧电极直接置于患者胸骨旁2、3肋 间正常皮肤上来测定PtC02。 • 无创性、续监测组织氧合。Ptc02测定的是 传感器下面皮肤组织的P02。 • 组织氧张力除了受PaO2影响外，还受组织 血液灌注量的影响。组织血液灌注量正常 时，Ptc02与PaO2具有非常好的相关性。
Fife CE; Smart DR; Undersea Hyperb Med. 2009V36N1:43-53
Gustavo Luiz Bu Crit Care Med 2009 Vol. 37, No. 4
• orthogonal polarization spectral device was used to investigate the sublingual microcirculation • the first dose (50 mg) of hydrocortisone • and 1, 2, 4, and 24 hours later • Global hemodynamic variables were similar at all • study time points.
Transcutaneous oximetry in clinical practice: consensus statements from an expert panel based on evidence.
Intensive Care Med. 2009 Jun;35(6):1106-9. Epub 2009 Jan 29. Thenar oxygen saturation measured by near infrared spectroscopy as a noninvasive predictor of low central venous oxygen saturation in septic patients. Mesquida J, Masip J, Gili G, Artigas A, Baigorri F.
微循环的本质属性
• 田牛 微循环学杂志，1994.1 田牛.微循环学杂志， 微循环学杂志 直接参与组织、细胞的物质、信息、 直接参与组织、细胞的物质、信息、 物质 能量传递的血液 淋巴液、 传递的血液、 能量传递的血液、淋巴液、组织液的流动 称之为微循环。 称之为微循环。
SIRS的临床特征
• 心输出量的增加、全身血管阻力的降低 心输出量的增加、 • 动静脉氧分压差缩小 • 血乳酸水平增加 反映细胞对氧(或底物 的利用障碍 反映细胞对氧 或底物)的利用障碍。用于产生细 或底物 的利用障碍。 胞必需能量的氧和底物的输送或利用障碍可导致 SIRS,并形成 并形成MODs 并形成
• 《2008年严重脓毒症与脓毒症休克治 疗国际指南》
建议仅在成年脓毒症休克患者对容量复苏 和血管活性药物反应差时静脉给予氢化可 的松(推荐级别2C)
The effect of increasing doses of norepinephrine on tissue oxygenation and microvascular flow in patients with septic shock*
方法
• N=20 • Sublingual microcirculation was evaluated by sidestream darkfield (SDF) imaging • DO2 and VO2, • lactate, • albumin-corrected anion gap, • gastric intramucosal-arterial PCO2 difference (∆PCO2).
Arnaldo Dubin .Critical Care 2009, 13:R92
Arnaldo Dubin. Critical Care 2009, 13:R92
Arnaldo Dubin .Critical Care 2009, 13:R92
Arnaldo Dubin .Critical Care 2009, 13:R92
Effects of hydrocortisone on microcirculatory alterations in patients with septic shock* Gustavo Luiz Bu¨ cheleCrit Care Med 2009 Vol. 37, No. 4
Effects of hydrocortisone on microcirculatory alterations in patients with septic shock
Gustavo Luiz Bu Crit Care Med 2009 Vol. 37, cortisone on microcirculatory alterations in patients with septic shock
Effects of hydrocortisone on microcirculatory alterations in patients with septic shock
Gustavo Luiz Bu Crit Care Med 2009 Vol. 37, No. 4
Figure 2. Evolution of microcirculation variables during study time periods. Perfused small vessels .
The prognostic value of muscle StO2 in
critically ill patients • SUMMARY: Near-infrared spectroscopy provides a noninvasive measure of muscle oxygen metabolism and microvascular dysfunction in critically ill patients. It may be useful to guide the management of