Marie Wagner, Eveline Anzinger, Florian Hey, Karl Reiter, Julius Z Wermelt, Belén Pastor-Villaescusa, Orsolya Genzel-Boroviczény, Claudia Nussbaum
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引用次数: 4
摘要
背景:手术中监测大循环提供的器官灌注质量信息有限。目的:探讨儿童围手术期微循环测量的可行性。方法:采用手持式视频显微镜观察11例(19个月~ 10岁)手术> 120 min患儿的舌下微血管,观察时间点为:麻醉诱导后T0;T1)麻醉结束前,T2)术后6 h, T3)术后24 h。结果:所有患儿在T0和T1时均可进行测量。在T2和T3时,由于呼吸受损和缺乏配合,分别局限于6名和4名婴儿成像。与T0相比,T1时毛细血管密度降低(8.1 mm/mm2 [4.0-17.0] vs. 10.6 mm/mm2 [5.1-19.3];p = 0.01),且与去甲肾上腺素剂量呈负相关(Pearson r = -0.65;p = 0.04)。微血管流量和血清糖萼生成物Syndecan-1和Hyaluronan在T0至T1期间显著增加。结论:儿童围手术期微循环监测需要大量的人力和后勤资源,仍限制了其常规应用。大手术与微血管改变和糖萼紊乱有关。对患者预后可能产生的影响需要进一步评估。应集中精力开发旨在促进儿童微循环监测的下一代设备。
Monitoring of the microcirculation in children undergoing major abdominal and thoracic surgery: A pilot study.
Background: Monitoring of the macrocirculation during surgery provides limited information on the quality of organ perfusion.
Objective: We investigated the feasibility of perioperative microcirculatory measurements in children.
Methods: Sublingual microvessels were visualized by handheld videomicroscopy in 11 children (19 mo - 10 yrs) undergoing surgery > 120 min at four time points: T0) after induction of anesthesia; T1) before end of anesthesia, T2) 6 h post surgery and T3) 24 h post surgery.
Results: Measurements were feasible in all children at T0 and T1. At T2 and T3, imaging was restricted to 6 and 4 infants, respectively, due to respiratory compromise and missing cooperation. The capillary density was reduced at T1 compared to T0 (8.1 mm/mm2 [4.0-17.0] vs. 10.6 mm/mm2 [5.1-19.3]; p = 0.01), and inversely related to norepinephrine dose (Pearson r = -0.65; p = 0.04). Microvascular flow and serum glycocalyx makers Syndecan-1 and Hyaluronan increased significantly from T0 to T1.
Conclusion: Perioperative microcirculatory monitoring in children requires a high amount of personal and logistic resources still limiting its routine use. Major surgery is associated with microvascular alterations and glycocalyx perturbation. The possible consequences on patient outcome need further evaluation. Efforts should concentrate on the development of next generation devices designed to facilitate microcirculatory monitoring in children.
期刊介绍:
Clinical Hemorheology and Microcirculation, a peer-reviewed international scientific journal, serves as an aid to understanding the flow properties of blood and the relationship to normal and abnormal physiology. The rapidly expanding science of hemorheology concerns blood, its components and the blood vessels with which blood interacts. It includes perihemorheology, i.e., the rheology of fluid and structures in the perivascular and interstitial spaces as well as the lymphatic system. The clinical aspects include pathogenesis, symptomatology and diagnostic methods, and the fields of prophylaxis and therapy in all branches of medicine and surgery, pharmacology and drug research.
The endeavour of the Editors-in-Chief and publishers of Clinical Hemorheology and Microcirculation is to bring together contributions from those working in various fields related to blood flow all over the world. The editors of Clinical Hemorheology and Microcirculation are from those countries in Europe, Asia, Australia and America where appreciable work in clinical hemorheology and microcirculation is being carried out. Each editor takes responsibility to decide on the acceptance of a manuscript. He is required to have the manuscript appraised by two referees and may be one of them himself. The executive editorial office, to which the manuscripts have been submitted, is responsible for rapid handling of the reviewing process.
Clinical Hemorheology and Microcirculation accepts original papers, brief communications, mini-reports and letters to the Editors-in-Chief. Review articles, providing general views and new insights into related subjects, are regularly invited by the Editors-in-Chief. Proceedings of international and national conferences on clinical hemorheology (in original form or as abstracts) complete the range of editorial features.