Guiding Significance Of Sublingual Microcirculation Monitoring In The Treatment Of Sepsis

Objective:The purpose of this study was to confirm that by monitoring the parameters of sublingual microcirculation in sepsis patients,early tissue perfusion could be identified,and fluid therapy and vasoactive drugs could be applied more accurately compared with conventional macro indicators,so as to effectively avoid the overload of circulation capacity,and finally achieve the purpose of improving the organ function of patients.Methods:A prospective single-blind randomized controlled trial?RCT?method was used to include 80 patients who met the diagnostic criteria for sepsis?sepsis3.0?admitted to the ICU of Weihai Central Hospital from January 2019 to January 2020.The random number table method was used to divide the patients into the regular group and the microcirculation group,with 40 cases in each group.Both groups were treated according to the 1-hour bundle of sepsis treatment guidelines.During the period,the regular group took the mean arterial pressure?MAP??65mmhg and lactic acid?Lac??2mmol/L as the targets to guide the resuscitation;Microvascualr flow index?MFI??2.6 was used to guide the recovery of the microcirculation group on the basis of the recovery target of the regular group.Sublingual microcirculation monitoring was performed by the same physician in all patients,but he was not involved in the formulation or modification of treatment plans for both groups.The parameters of sublingual microcirculation in microcirculation group were released in time,while those in regular group were kept confidential.The indexes of different time nodes?0h,1h,3h,24h,48h,72h?were recorded,including liquid intake?between two consecutive time nodes?,norepinephrine dosage,MFI,proportion of perfusion vessels?PPV?,cardiac index?CI?,average arterial pressure,heart rate,central venous pressure?CVP?,Lac,central venous oxygen saturation?Scv0₂?,etc.Results:1.The basic conditions of patients in the two groups include age,sex,weight,height,infection site,acute physiology and chronic health evaluation??APACHE??at admission,and there is no statistical difference.2.The dosage of liquid and norepinephrine:There was no significant difference between the two groups in the first 1h and the first 3h of the liquid intake between each two time nodes at the beginning of recovery,but at 24 h,48 h and 72 h,compared with the regular group,the amount of liquid in the microcirculation group decreased,P<0.05,which was statistically significant.With norepinephrine,the dosage of the microcirculation group at 3h,24h and 48h increased compared with the regular group,P<0.05,which was statistically significant.There was no difference in the dosage of norepinephrine between the two groups at 72 h.3.Macro hemodynamic indexes:The CVP of the microcirculation group at 24h,48h and 72h was lower than that of the regular group?P<0.05?,which was statistically significan.There was no significant difference in heart rate and mean arterial pressure between the two groups.The cardiac output was measured by bedside ultrasound and the cardiac index?CI?was calculated and there was no significant difference between the two groups.4.Tissue perfusion index:The PPV value of microcirculation group at3h,24 h,48 h and 72 h was better than that of the regular group?P<0.05?,which was statistically significant.The MFI of microcirculation group at 3h,24 h,48 h and 72 h was better than that of regular group?P<0.05?,which was statistically significant.The Pcv-aCO₂ of microcirculation group at 24 h,48 h and 72 h was better than that in regular group?P<0.05?,which was statistically significant.Compared with the regular group,the lactate value of the microcirculation group at 3h,24h and 48h improved significantly?P<0.05?.There was no significant difference in ScvO₂ between the two groups.5.Organs and systems function indicators:The brain natriuretic peptide of patients in the microcirculation group improved from 48h to 72h compared with the regular group,48h1760?810,5950?vs.7800?1036,8945?,72h 1525?860,4845?vs.4880?1010,8630?,P<0.05,the difference was statistically significant.The serum creatinine of patients in microcirculation group was improved at 72h compared with that in regular group,78?60,98?vs.89?81,100?,P<0.05,the difference was statistically significant.Patients in microcirculation group were less than those in regular group in blood purification treatment,?3vs7?,P<0.05,the difference was statistically significant.There was no significant difference in glutamic-pyruvictransaminase,prothrombin time and platelet count between the two groups.There was no significant difference in APACHE?score between the two groups in every 24 hours.Conclusion:In this study,combined with macroscopic hemodynamic indicators,the measured parameters of microcirculation were used to guide fluid resuscitation and norepinephrine application.Microcirculation was significantly improved during early fluid resuscitation in sepsis.After 3 hours,the microcirculation group was guided by MFI adjust the amount of fluid resuscitation and rational use of norepinephrine to improve microcirculation perfusion and tissue metabolism and reduce damage to heart and kidney function.It is suggested that sublingual microcirculation monitoring has guiding significance in resuscitation treatment of sepsis patients.