Prognositc value of sublingual microcirculation in hemorrhagic shock patients

Qu Jin-long; Zhao liang; Guan Jun; Lin Zhao-feng

doi:10.3969/j.issn.1002-1949.2017.10.009

Abstract：Objective To investigate the sublingual microcirculation changes after the resuscitation in hemorrhagic shock patients and the possibility to guide the fluid resuscitation of these patients. Methods A total of 59 patients, admitted to ICU from June 1, 2016 to June 30, 2017, diagnosed with hemorrhagic shock were studied. They were divided into experiment group and control group in random. Using bypass dark vision imaging technology ( SDF) to observe the the sublingual microcirculation changes as the resuscitation began, 2 h later, 6 h later, 12 h later, and 24 h later. We also recorded these time points of microcirculation data, and the amount of fluid of 24 h resuscitation, APACHEⅡ score, SOFA scores and other data. Results There was no differences in ages, gender, APACHEⅡ scores and the sublingual microcirculation between the two groups at the beginning of the of the fluid resuscitation. The results of sublingual microcirculation monitoring showed that after the fluid resuscitation, two groups of microcirculation data showed positive trends. The amount of resuscitation fluid was adjusted according to the sublingual microcirculation status in experimental group. So the amount of recovered fluid of experimental group was less than that of control group during the first 24 h. The mean arterial pressure, sublingual microcirculation, APACHEⅡscore, SOFA score and oxygenation index showed no significant difference in the first 24 h. With the prolonged experimental time(2 days-7 days),in 48h, SOFA score and oxygenation index of the experimental groupwere better than those of the control group(P<0. 05),and in 7th day, the APACHEⅡscores, SOFA scores were also better than those of the control group(P<0. 05). And there was significant difference between the time of vasoactive drug use and the duration of ventilator support. Although the mortality rate between the two groups was no statistically different(P>0. 05). Conclusion The sublingual microcirculation can be used as an indicator to monitor the microcirculation of hemorrhagic shock, to a certain extent, it also can guide the fluid resuscitation in hemorrhagic shock patients, which is conducive to control the recovery fluid and protect the organ function, especially the respiratory function.