急性细菌感染发生压力性损伤患者的临床特点及微循环状态改变情况分析

Analysis of clinical characteristics and changes in microcirculation status in patients with acute bacterial infection undergoing stress injury

目的 分析急性细菌感染发生压力性损伤患者的临床特点及微循环状态改变情况。方法 选取首都医科大学附属北京朝阳医院急诊科2022年1月至2022年6月收治的急性细菌感染患者70例,根据入院5d内是否发生皮肤压力性损伤分为压力性损伤组和非压力性损伤组。比较两组患者的基本临床资料,包括年龄、性别、入院营养状态评价、既往病史、急性感染病灶部位、机械通气及28d死亡情况;入院24、48、72h血常规(白细胞计数、血小板计数、血红蛋白)、D-二聚体、血乳酸、碱剩余、降钙素原、C反应蛋白等指标;序贯器官衰竭评分及急性生理与慢性健康Ⅱ评分;舌下微循环监测参数(包括De Backer评分、小血管密度、微血管血流指数、血流不均一指数、灌流血管比例和灌流血管密度)。结果 共52例患者完成本次研究,其中21例(40.4%)发生压力性损伤,作为压力性损伤组,其余31例为非压力性损伤组。24例(46.2%)患者最终诊断为脓毒症,压力性损伤组17例(81.0%),非压力性损伤组7例(22.6%),两组差异有显著性(P<0.05)。随访28d,共10例患者死亡,其中压力性损伤组4例(19.0%),非压力性损伤组6例(19.4%),两组差异无显著性(P>0.05)。两组患者年龄、性别、入院营养状态评价、基础疾病、感染病灶部位、实验室指标等方面差异均无显著性(P>0.05)。压力性损伤组入院72h的序贯器官衰竭评分高于非压力性损伤组(P<0.05),且压力性损伤组与非压力性损伤组入院48h和72h的序贯器官衰竭评分均高于同组入院24h(P<0.05)。压力性损伤组入院24h平均动脉压低于非压力性损伤组(P<0.05),入院24、48、72h血乳酸水平均高于非压力性损伤组(P<0.05),碱剩余水平低于非压力性损伤组(P<0.05)。压力性损伤组入院24、48、72h的微循环流量指数、灌注血管比例和灌注血管密度均低于非压力性损伤组,血流不均一指数高于非压力性损伤组,差异有显著性(P<0.05)。压力性损伤组舌下微循环各参数的48h变化率与72h变化率比较差异无显著性(P>0.05)。结论 急性细菌感染患者在发生压力性损伤时,微循环状态发生异常,舌下微循环监测在急性细菌感染患者压力性损伤的防治方面具有潜在应用价值。

Objective Analyze the clinical characteristics and changes in microcirculation status of patients with acute bacterial infection who experience pressure injury.Method 70 patients with acute infection were divided into pressure injury(PI)group and non-pressure injury(NPI)group according to whether skin pressure injury occurred.All patients were from January 2022 to June 2022 in Beijing Chaoyang Hospital,Capital Medical University.The basic information collected includes the patient’s age,sex and previous medical history,the site of this acute infection,whether mechanical ventilation was used during treatment,and whether he died within 28 days.Collect the laboratory indexes of the patients at the 24th,48th and 72h after admission,including blood routine(white blood cell count,platelet count,hemoglobin),D-dimer level,blood lactate level(LAC),base residue(BE),procalcitonin(PCT),C-reactive protein(CRP),etc.According to the examination results,the patients were given SOFA score and APACHII score.The sublingual microcirculation monitor was used to monitor sublingual microcirculation,including De Backer score,total vessel density(TVD),microvascular flow index(MFI),blood flow heterogeneity index(FHI),proportion of perfused vessels(PPV)and perfusion vessel density(PVD).The operation of the device was based on the flow dark field(SDF)technology.Result Fifty-two patients completed this study,21 patients developed stress injury and were included in PI group,and the remaining 31 patients were included in NPI group.24 patients finally diagnosed sepsis,17 patients were in PI group and 7 patients were in NPI group,the two groups were significant(P<0.05).At followup 28d,10 patients died,4 patients of which were in PI group and the remaining 6 patients were in NPI group,there was no significant difference(P>0.05).There were no significant differences in age,sex,nutritional status evaluation,past medical history,acute infection focus and laboratory indicators between the two groups.At 48h and 72h after admission,the SOFA score and blood lactate level in PI group were significantly higher than those in NPI group(P<0.05),while the alkali residue level was lower than that in NPI group(P<0.05).At the same time,MFI of NPI group was significantly higher than that of PI group at all time points(P<0.05),while FHI was significantly lower than that of PI group(P<0.05).There was no significant difference in microcirculation index within the same group,and there was no difference in 48h change rate and 72h change rate.Conclusion There is a significant difference in microcirculation status in patients with acute bacterial infection when pressure injury occurs.The monitoring of sublingual microcirculation has potential application value in the prevention and treatment of pressure injury in patients with acute bacterial infection.