微循环障碍研究进展对烧伤休克和烧伤脓毒症休克治疗的启发

Inspiration from the research advances in microcirculatory dysfunction to the treatment of burn shock and burn septic shock

微循环障碍是休克重要的病理生理变化。近10年来,许多有关微循环障碍机制的研究都涉及血管内皮细胞糖萼损害、大循环-微循环失偶联、血管低反应性以及微循环监测等方面。据此,该文讨论如何将这些研究结果应用于烧伤患者,目的是提醒临床医师在烧伤休克和烧伤脓毒症休克治疗过程中关注微循环改善情况,维持血流动力学的协调性。此外,随着精准、可靠的微循环监测技术的发展,有必要开展多中心的临床研究,以揭示大循环和微循环指标相结合的目标导向性休克复苏方案的临床意义。

Microcirculatory dysfunction is an important pathophysiological change of shock.In the last decade,many researches on the mechanism of microcirculatory dysfunction have been involved in areas such as the glycocalyx damage of vascular endothelial cells,macrocirculation-microcirculation discoupling,vascular hyporeactivity,and microcirculation monitoring.Accordingly,this paper discussed how these research findings can be applied to burn patients,with the aim of alerting the clinicians to improving microcirculation,and maintaining hemodynamic coordination during the treatment of burn shock and burn septic shock.In addition,with the development of accurate and reliable microcirculation monitoring techniques,it is necessary to carry out multi-center clinical trials to reveal the clinical significance of target-oriented shock resuscitation protocol combining macrocirculatory and microcirculatory parameters.