Microcirculation monitoring and management of sepsis: from a clinical practice perspective
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摘要: 脓毒症是重症监护治疗病房患者死亡的主要原因之一，多年来为解决这一难题研究人员提出了多种治疗方法，但脓毒症尤其是脓毒性休克患者的预后并未得到改善。随着对脓毒症研究的不断深入，发现微循环障碍是脓毒症导致多器官衰竭的关键，而脓毒症病死率与器官衰竭密切相关，因此在脓毒症治疗过程中微循环的监测和管理尤为重要。本文就临床实践中可用的微循环监测手段与管理方法进行综述，供应用参考。Abstract: Sepsis is one of the main causes of death in intensive care unit patients. Over the years, researchers have proposed a variety of treatment methods to solve this problem, but the prognosis of patients with sepsis, especially septic shock, has not improved. With the deepening of research on sepsis, it has been found that microcirculation disorder is the key to multiple organ failure caused by sepsis, and the mortality rate of sepsis is closely related to organ failure. Therefore, monitoring and management of microcirculation is particularly important in the course of sepsis treatment. This article reviews the microcirculation monitoring tools and management methods available in clinical practice for reference.
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Key words:
- sepsis /
- microcirculation /
- capacity to monitor /
- bundle
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表 1 微循环临床的监测
分类 名称 临床表现间接评估 中心静脉血氧饱和度或混合中心静脉血氧饱和度 动静脉二氧化碳分压差 血乳酸 皮肤情况 尿量 意识程度和精神状态 脑氧饱和度 可视化手段直接监测 手持式电子显微镜 激光多普勒成像 近红外光谱成像 以超声为基础评估 超声心动图 各器官多普勒超声 
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表 2 微循环的临床管理
方法或药物 作用 大循环复苏 保证足够的灌注压 乳酸水平管理 反映组织缺氧和功能障碍的重要标志 保障内皮细胞屏障功能 减少液体渗漏和组织液淤积，防止组织缺氧 微血管自律运动恢复 调控各个器官和组织的血流分布情况和灌注水平 早期使用抗生素 病因治疗
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