Effect of early goal directed therapy on tissue perfusion in patients with septic shock

BACKGROUND:This study aimed to observe the effect of early goal directed therapy(EGDT)on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.METHODS:Patients with early septic shock(<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled(research time:12 months),and they didn't meet the criteria of EGDT.Patients who had one of the following were excluded:stroke,brain injury,other types of shock,severe heart failure,acute myocardial infarction,age below 18 years,pregnancy,end-stage disease,cardiac arrest,extensive burns,oral bleeding,difficulty in opening the mouth,and the onset of septic shock beyond 24 hours.Patients treated with the standard protocol of EGDT were included.Transcutaneous pressure of oxygen and carbon dioxide(PtcO_2,PtcCO_2) were monitored and hemodynamic measurements were obtained.Side-stream dark field(SDF) imaging device was applied to obtain sublingual microcirculation.Hemodynamics,tissue oxygen,and sublingual microcirculation were compared before and after EGDT.If the variable meets the normal distribution,Student's t test was applied.Otherwise,Wilcoxon's rank-sum test was used.Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method.RESULTS:Twenty patients were involved,but one patient wasn't analyzed because he didn't meet the EGDT criteria.PtcO_2 and PtcCO_2 were monitored in 19 patients,of whom sublingual microcirculation was obtained.After EGDT,PtcO_2 increased from 62.7+24.0 mmHg to 78.0±30.9mmHg(P<0.05) and tissue oxygenation index(PtcO_2/FiO_2) was 110.7+60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT(P<0.05).The difference between PtcCO_2 and PCO_2 decreased significantly after EGDT(P<0.05).The density of perfused small vessels(PPV) and microcirculatory flow index of small vessels(MFI) tended to increase,but there were no significant differences between them(P>0.05).PtcO_2,PtcO_2/FiO_2,and PtcCO_2 were not linearly related to central venous saturation,lactate,oxygen delivery,and oxygen consumption(P>0.05).CONCLUSION:Peripheral perfusion was improved after EGDT in patients with septic shock,and it was not exactly reflected by the index of systemic perfusion.

Effect of sliding-cup along governor vessel on tcpO_2 and tapCO_2 in Mìngmén(命门 GV 4) point of sub-healthy humans: observation on different cupping pressure

Objective To explore the effects of sliding-cup with different parameters on energy metabolism in the body by observing the effect of sliding-cup along the governor vessel on transcutaneous partial pressures of oxygen and carbon dioxide in Mìngmén（命门 GV 4） in sub-healthy people. Methods A total of 10 sub-healthy adults at rest were observed and sliding-cup along the governor vessel were conducted with three different parameters, jar-pressure of –0.01~ –0.02 MPa with sliding-cup for 5 min, jar-pressure of –0.02~ –0.03 MPa with sliding-cup for 5 min and jar-pressure of –0.02~ –0.03 MPa with slidingcup for 3 min. Peri Flux System5000 PF5040 module was employed to monitor the changes of transcutaneous partial pressures of oxygen（tcp O2） and carbon dioxide（tcp CO2） in GV 4 at 0 min, 5 min, 10 min, 15 min, 20 min, 25 min and 30 min after sliding-cup with above different interventions in sub-healthy subjects. Results After sliding-cup, tcp O2 increased at first and then decreased over time; there was no difference in tcp O2 after sliding-cupping with different parameters（all P0.05）. After sliding-cup, tcp CO2 decreased; there was no difference in tcp CO2 after sliding-cup with different parameters（all P0.05）. Conclusion Sliding-cup has a sustained effect on the body and can speed up the energy metabolism in the body.