切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (09) : 689 -692. doi: 10.3877/cma.j.issn.1674-0785.2019.09.010

所属专题: 文献

综述

经皮氧分压监测在脓毒性休克患者中的临床应用
杨朋磊1, 於江泉2,(), 郑瑞强2, 陈含冰1   
  1. 1. 116044 大连医科大学
    2. 225001 江苏扬州,苏北人民医院重症医学科
  • 收稿日期:2019-03-22 出版日期:2019-05-01
  • 通信作者: 於江泉
  • 基金资助:
    江苏省卫生计生委面上项目(H201660); 江苏省青年医学人才项目(QNRC2016318); 江苏省社会发展项目(BE2017691); 扬州市社会发展计划-面上项目(YZ2018075)

Clinical application of percutaneous oxygen partial pressure monitoring in patients with septic shock

Penglei Yang1, Jiangquan Yu2,(), Ruiqiang Zheng2, Hanbing Chen1   

  1. 1. Dalian Medical University, Dalian 116044, China
    2. Intensive Care Unit, Northern Jiangsu People′s Hospital, Yangzhou 225001, China
  • Received:2019-03-22 Published:2019-05-01
  • Corresponding author: Jiangquan Yu
  • About author:
    Corresponding author: Yu Jiangquan, Email:
引用本文:

杨朋磊, 於江泉, 郑瑞强, 陈含冰. 经皮氧分压监测在脓毒性休克患者中的临床应用[J]. 中华临床医师杂志(电子版), 2019, 13(09): 689-692.

Penglei Yang, Jiangquan Yu, Ruiqiang Zheng, Hanbing Chen. Clinical application of percutaneous oxygen partial pressure monitoring in patients with septic shock[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(09): 689-692.

脓毒症和脓毒性休克是ICU患者最常见的死亡原因之一。液体治疗是治疗脓毒性休克的重要手段之一,如何进行液体治疗仍然存在很大争议,目前普遍以容量反应性来指导液体治疗。但也有学者发现,即使宏观血流动力学恢复,微循环仍可能存在障碍。休克的本质是微循环障碍,如何监测微循环状况及利用微循环监测对脓毒性休克患者进行早期诊断、病情评估,以及指导液体治疗可能是今后研究的方向。经皮氧分压(TcPO2)监测技术是通过无创方法将皮肤表面电极加热来估测组织氧分压的技术手段。越来越多的学者研究发现TcPO2在监测脓毒症和脓毒性休克患者局部组织灌注不足、预测患者预后、指导液体治疗等方面有重要的临床价值。因此本文对TcPO2在脓毒性休克中的应用进行整理和总结。

Sepsis and septic shock are one of the most common fatal causes of patients in Intensive Care Unit. Fluid therapy is one of the important methods for the treatment of septic shock, but how to use fluid therapy is still a point of hot debate. Volume responsiveness has been widely used to guide fluid therapy. However, some scholars have found that patients suffer from microcirculatory disturbance, even with hemodynamics recovery. It may be the future development direction that doctors monitor microcirculation status to guide the diagnosis, severity evaluation, and fluid therapy of septic shock. Transcutaneous oxygen pressure (TcPO2) is a technique for estimating tissue oxygen pressure by heating skin surface electrodes. An increasing number of studies have found that TcPO2 could show microcirculatory perfusion state, guide fluid therapy, and help evaluate prognosis. In this article, we will summarize the application of TcPO2 in patients with septic shock.

1
Reinhart K, Bauer M, Riedemann NC, et al. New approaches to sepsis: molecular diagnostics and biomarkers [J]. Clin Microbiol Rev, 2012, 25(4): 609-634.
2
Xu JY, Ma SQ, Pan C, et al. A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study [J]. Crit Care, 2015, 19(1): 130.
3
De Backer D, Creteur J, Preiser JC, et al. Microvascular blood flow is altered in patients with sepsis [J]. Am J Respir Crit Care Med, 2002, 166(1): 98-104.
4
曹钰,柴艳芳,邓颖. 中国脓毒症/脓毒性休克急诊治疗指南 [J]. 临床急诊杂志, 2018, 19(9): 567-588.
5
Martin K, Weiss SL. Initial resuscitation and management of pediatric septic shock [J]. Minerva Pediatr, 2015, 67(2): 141-158.
6
Gasim GI, Musa IR, Yassin T, et al. Sepsis in Buraidah Central Hospital, Qassim, Kingdom of Saudi Arabia [J]. Int J Health Sci, 2016, 10(2): 175-181.
7
Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine [J]. Intensive Care Med, 2014, 40(12): 1795-1815.
8
Yu M, Morita SY, Daniel SR, et al. Transcutaneous pressure of oxygen:noninvasive and early detector of peripheral shock and outcome [J]. Shock, 2006, 26(5): 450-456.
9
Tatevossian RG, Wo CC, Velmahos GC, et al. Transcutaneous oxygen and CO2 as early warning of tissue hypoxia and hemodynamic shock in critically ill emergency patients [J]. Crit Care Med, 2000, 28(7): 2248-2253.
10
Xu J, Peng X, Pan C, et al. Fluid responsiveness predicted by transcutaneous partial pressure of oxygen in patients with circulatory failure: a prospective study [J]. Ann Intensive Care, 2017, 7(1): 56.
11
Schlager O, Gschwandtner ME, Willfort-Ehringer A, et al. Transcutaneous oxygen tension monitoring in critically ill patients receiving packed red blood cells [J]. J Crit Care, 2014, 29(6): 1057-1062.
12
Tremper KK, Waxman K, Shoemaker WC. Effects of hypoxia and shock on transcutaneous PO2 values in dogs [J]. Crit Care Med, 1979, 7(12): 526-531.
13
钱虎声,张柏银,邝耀麟. 经皮氧分压测定在周围血管疾病中的应用 [J]. 上海医学, 1994, 17(9): 550-553.
14
De Backer D, Ospina-Tascon G, Salgado D, et al. Monitoring the microcirculation in the critically ill patient: current methods and future approaches [J]. Intensive Care Med, 2010, 36(11): 1813-1825.
15
俞森洋. 现代机械通气的监护和临床应用 [M]. 北京: 北京协和医科大学出版社, 2000: 221-227.
16
刘玉梅,何少茹. 经皮二氧化碳分压及氧分压监测在新生儿重症监护室中的应用 [J]. 中国新生儿科杂志, 2009, 24(1): 15-17.
17
Huch R, Huch A, Lubbers DW. Transcutaneous measurement of blood P(O2) (tcP(O2)). Method and application in perinatal medicine [J]. J Perinat Med, 1973, 1(3): 183-191.
18
唐林林,符跃强,刘成军. 经皮无创血气监测在儿童危重症中的应用价值评估 [J]. 重庆医科大学学报, 2017, 42(1): 43-47.
19
Poets CF, Southall DP. Noninvasive monitoring of oxygenation in infants and children: Practical considerations and areas of concern [J]. Pediatrics, 1994, 93(5): 737-746.
20
Gottrup F, Firmin R, Chang N. Continuous direct tissue oxygen tension measurement by a new method using an implantable silastic tonometer and oxygen polarography [J]. Am J Surg, 1983, 146(3): 399-403.
21
Jonsson K, Jensen JA, Goodson IWH. Assessment of perfusion in postoperative patients using tissue oxygen measurements [J]. Br J Surg, 1987, 74(4): 263-267.
22
Van Esbroeck G, Gys T, Hubens A. Evaluation of tissue oximetry in perioperative monitoring of colorectal surgery [J]. Br J Surg, 1992, 79(6): 584-587.
23
徐靓,严静,龚仕金. 感染性休克患者经皮氧分压与血乳酸的相关性 [J]. 中华内科杂志, 2018, 57(11): 841-843.
24
公茂伟,米卫东,傅强. 经皮氧分压监测在骨科手术中的应用 [J]. 北京医学, 2011, 33(8): 629-631.
25
Tremper KK, Shoemaker WC. Transcutaneous oxygen monitoring of critically ill adults, with and without low flow shock [J]. Crit Care Med, 1981, 9(10): 706-709.
26
Dyson A, Singer M. Tissue oxygen tension monitoring: Will it fill the void? [J]. Curr Opin Crit Care, 2011, 17(3): 281-289.
27
Dyson A, Stidwill R, Taylor V, et al. The impact of inspired oxygen concentration on tissue oxygenation during progressive haemorrhage [J]. Intensive Care Med, 2009, 35(10): 1783-1791.
28
He HW, Liu DW, Long Y, et al. The peripheral perfusion index and transcutaneous oxygen challenge test are predictive of mortality in septic patients after resuscitation [J]. Crit Care, 2013, 17(3): R113.
29
Mari A, Vallée F, Bedel J, et al. Oxygen challenge test in septic shock patients: Prognostic value and influence of respiratory status [J]. Shock, 2014, 41(6): 504-509.
30
Yu M, Chapital A, Ho HC, et al. A prospective randomized trial comparing oxygen delivery versus transcutaneous pressure of oxygen values as resuscitative goals [J]. Shock, 2007, 27(6): 615-622.
31
He HW, Liu DW, Long Y, et al. The transcutaneous oxygen challenge test: A noninvasive method for detecting low cardiac output in septic patients [J]. Shock, 2012, 37(2): 152-155.
32
Falstie-Jensen N, Spaun E, Brochner-Mortensen J, et al. The influence of epidermal thickness on transcutaneous oxygen pressure measurements in normal persons [J]. Scand J Clin Lab Invest, 1988, 48(6): 519-523.
33
Nishiyama T, Nakamura S, Yamashita K. Comparison of the transcutaneous oxygen and carbon dioxide tension in different electrode locations during general anaesthesia [J]. Eur J Anaesthesiol, 2006, 23(12): 1049-1054.
[1] 作者. 脓毒症与脓毒性休克[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 0-.
[2] 林乐清, 曹伟, 唐泽文, 王白永, 王磊, 张宁, 唐文学. 脓毒性休克患者液体复苏时外周灌注指数的临床指导价值研究[J]. 中华危重症医学杂志(电子版), 2022, 15(06): 460-465.
[3] 康绍涛, 布祖克拉·阿布都艾尼, 李英杰, 拜合提尼沙·吐尔地. 体外膜肺氧合治疗脓毒症患者生存预后的Meta分析[J]. 中华危重症医学杂志(电子版), 2022, 15(01): 51-59.
[4] 张强, 程铖, 徐日新, 吴彩凤, 谢勇, 刘晓东, 梅宏斌, 曹天庆. 中性粒细胞与淋巴细胞比值对ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后微循环障碍的预测价值[J]. 中华危重症医学杂志(电子版), 2020, 13(05): 351-355.
[5] 陈文秀, 沈骁, 宋晓春, 孙加奎, 章文豪, 王翔, 刘颖, 刘汉, 施乾坤, 章淬, 穆心苇. 联合检测中性粒细胞与白蛋白比值和乳酸对脓毒性休克患者早期预后的评估价值[J]. 中华危重症医学杂志(电子版), 2020, 13(02): 100-105.
[6] 郭宝玉, 俞俊杰, 於江泉, 韩雪, 郭哲. 经皮肾镜术后并发脓毒症/脓毒性休克的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(06): 424-428.
[7] 郑少琴, 杨莎, 胡燕, 田青青. 脓毒性休克并发肺部感染及未分化结缔组织病一例[J]. 中华肺部疾病杂志(电子版), 2022, 15(01): 135-137.
[8] 秦丽, 林江, 陈代刚, 江洪艳, 金妮, 黄毅. 库欣综合征合并致命性多机会感染一例[J]. 中华肺部疾病杂志(电子版), 2021, 14(06): 843-844.
[9] 晋正敏, 朱琴, 龙云霞. 严重脓毒症/脓毒症休克患者预后的高危因素[J]. 中华肺部疾病杂志(电子版), 2020, 13(05): 607-611.
[10] 刘祥祥, 林丹婷, 孙云晓, 甘嘉禾, 金杉杉, 玛依努尔·于苏甫, 王宁利. 颅内压下降所致眼颅压力梯度增大对视盘血流密度影响的临床研究[J]. 中华眼科医学杂志(电子版), 2019, 09(05): 273-280.
[11] 张璐, 李响, 夏世宏, 童琦, 孙英杰, 马雪丽. 脓毒症休克的诊治在精准医学时代下的发展及临床应用[J]. 中华重症医学电子杂志, 2021, 07(02): 169-173.
[12] 赵国敏, 陆非平. ScvO2和Pcv-aCO2在脓毒性休克早期目标指导治疗中的价值[J]. 中华重症医学电子杂志, 2021, 07(02): 137-141.
[13] 孙禾, 何春凤, 吴晓东, 韩蕙泽, 施毅, 李强. 头孢他啶-阿维巴坦治疗碳青霉烯耐药的肺炎克雷伯菌脓毒性休克的临床分析[J]. 中华重症医学电子杂志, 2021, 07(01): 76-80.
[14] 刘芬, 黄天晴, 杨铱琳, 刘慧姝. 98例脓毒性休克患者的临床分析[J]. 中华产科急救电子杂志, 2020, 09(03): 175-179.
[15] 张继松, 王聿明, 郑彦俊, 祁星, 陈培莉, 史雯, 陈影, 杨之涛, 毛恩强, 陈尔真. NGAL对脓毒症/脓毒性休克患者预后的预测作用(已撤稿)[J]. 中华卫生应急电子杂志, 2020, 06(04): 202-208.
阅读次数
全文


摘要