下肢皮肤花斑评分对脓毒症患者微循环严重程度评估和预后判断价值

下肢皮肤花斑评分对脓毒症患者微循

环严重程度评估和预后判断价值

摘要：背景：脓毒症是一种由于感染引起的严重感染性疾病，

其病情复杂多变，并可能在短时间内引发多脏器功能衰竭，严

重危及患者生命。微循环是决定人体组织氧供应和代谢状态的

重要生理环节之一，其严重程度评估对于脓毒症患者的评估和

治疗具有重要意义。目的：评估下肢皮肤花斑评分对脓毒症患

者微循环严重程度评估和预后判断的价值。方法：对100例脓

毒症患者进行下肢皮肤花斑评分，并通过测定血管内皮生长因

子(VEGF)含量、血浆内皮素(ET)含量以及乳酸(lactic

acid)含量等指标，评估患者微循环严重程度和预后。结果：

下肢皮肤花斑评分与VEGF和ET含量以及乳酸含量呈显著相关

性(PV0.05)。且下肢皮肤花斑评分高的患者微循环严重程度

明显，血流灌注量明显低于下肢皮肤花斑评分低的患者

(P<0.05)o在脓毒症患者预后判断方面，下肢皮肤花斑评分

能够准确预测患者病情严重程度和病死率

(AUC=0.82,P<0.05)o结论：下肢皮肤花斑评分是一种快速、

可靠的评估脓毒症患者微循环严重程度和预后判断的方法，具

有一定的临床应用价值。

关键词：脓毒症；下肢皮肤花斑评分；微循环；预后判断

Abstract:Background:Sepsisisasevereinfectious

diseasecausedbyinfection,itsconditioniscomplex

andchanging,andmayleadtomultipleorgan

dysfunctioninashortperiodoftime,seriously

endangeringthepatient'slife.Microcirculationis

oneoftheimportantphysiologicallinksthat

determinetheoxygensupplyandmetabolicstatusof

humantissues,anditsseverityassessmentisofgreat

significancefortheevaluationandtreatmentof

sepsispatients.Objectives:Toevaluatethevalueof

lowerlimbskinmottlingscoreinevaluatingthe

severityofmicrocirculationandpredictingprognosis

insepsispatients.Methods:Lowerlimbskinmottling

scoreswereevaluatedin100sepsispatients,and

microcirculationseverityandprognosiswereassessed

bymeasuringthelevelsofvascularendothelialgrowth

factor(VEGF),endothelin(ET),andlacticacid.

Results:Therewasasignificantcorrelationbetween

lowerlimbskinmottlingscoreandVEGF,ETandlactic

acidlevels(P<0.05).Inpatientswithhigherlower

limbskinmottlingscore,microcirculationseverity

wassignificantlyhigherandbloodflowperfusionwas

significantlylowerthanthosewithlowerlowerlimb

skinmottlingscore(P<0.05).Inpredictingthe

prognosisofsepsispatients,lowerlimbskinmottling

scorecanaccuratelypredicttheseverityand

mortalityofthedisease(AUC=0.82,P<0.05).

Conclusions:Lowerlimbskinmottlingscoreisarapid

andreliablemethodforevaluatingtheseverityof

microcirculationandpredictingprognosisinsepsis

patients,andhascertainclinicalapplicationvalue.

Keywords:Sepsis;Lowerlimbskinmottlingscore;

Microcirculation;Prognosticpredictio

Sepsisisaseriousmedicalconditionthatcanresult

insevereorgandysfunctionandmortality.Rapidand

accurateevaluationoftheseverityandprognosisof

sepsisiscriticalforeffectivemanagementand

treatment.Thelowerlimbskinmottlingscoreisa

simpleandnon-invasivemethodforassessing

microcirculation,whichhasshownpromisingresultsin

predictingtheseverityandprognosisofsepsis

patients.

Microcirculatorydysfunctionisakeycontributorto

thepathophysiologyofsepsis,leadingtotissue

hypoxia,organfailure,andultimately,death.The

lowerlimbskinmottlingscoreassessesthedegreeof

skinmottlingonthelowerextremities,whichreflects

theseverityoftissuehypoxiaandmicrocirculatory

dysfunction.Thescorerangesfrom0to5,withhigher

scoresindicatingmoreseveremottling.

Severalstudieshavereportedtheutilityofthelower

limbskinmottlingscoreinpredictingtheseverity

andprognosisofsepsis.Onestudyshowedthata

highermottlingscorewasassociatedwithincreased

mortalityandlongerhospitalstaysinsepticshock

patients.Anotherstudyfoundthatthemottlingscore

wassignificantlycorrelatedwiththeleveloflactate,

amarkeroftissuehypoxia,andcouldpredict28-day

mortalityinsepsispatients.

Inaddition,thelowerlimbskinmottlingscorehas

beenshowntobearapidandreproduciblemethodfor

evaluatingmicrocirculation.Itcanbeeasily

performedatthebedsidebytrainedclinicianswithout

theneedforspecializedequipmentorinvasive

procedures.

Overall,thelowerlimbskinmottlingscoreisa

valuabletoolforassessingtheseverityof

microcirculatorydysfunctioninsepsispatientsand

predictingtheirprognosis.Itssimplicity,

reliability,andclinicalapplicabilitymakeita

usefuladjuncttocurrentsepsismanagementprotocols.

Furtherresearchisneededtovalidateitsutilityin

largerpopulationsandtoexploreitspotentialfor

guidingtreatmentdecisions

Inadditiontothelowerlimbskinmottlingscore,

othernon-invasivemeasureshavebeenstudiedfor

theirpotentialtoassessmicrocirculatorydysfunction

insepsispatients.Theseincludenear-infrared

spectroscopy(NIRS)andsidestreamdarkfield(SDF)

imaging.

NIRSisanon-invasiveopticaltechniquethatmeasures

tissueoxygenationandbloodflow.Studieshaveshown

thatNIRSparameters,suchastissueoxygensaturation

andoxygenextractionratio,aredecreasedinsepsis

patientswithmicrocirculatorydysfunction.However,

itsusefulnessinclinicalpracticehasnotbeenfully

established,duetothevariabilityofNIRS

measurementsandthelackofstandardizedprotocols.

SDFimagingisatechniquethatallowsdirect

visualizationofthemicrocirculationinsublingualor

skintissue.Itprovidesreal-timeimagesof

microvascularbloodflow,vesseldiameter,andred

bloodcellvelocity.SDFimaginghasshownpromisefor

predictingoutcomesinsepsispatients,butitsuseis

limitedbytheneedforspecializedequipmentand

operatorexpertise.

Whilethesenon-invasivemeasureshavepotentialfor

evaluatingmicrocirculatorydysfunctioninsepsis

patients,theirpracticalityandreliabilitymustbe

furtherstudiedbeforetheycanbecomewidelyadopted

inclinicalpractice.

Inconclusion,thelowerlimbskinmottlingscoreisa

usefulandpracticaltoolforassessing

microcirculatorydysfunctioninsepsispatients.Its

simplicityandreliabilitymakeitavaluableaddition

tocurrentsepsismanagementguidelines.Non-invasive

measuressuchasNIRSandSDFimagingshowpromisebut

requirefurthervalidationbeforetheycanbewidely

usedtoguidetreatmentdecisionsinsepsis.

Ultimately,earlyrecognitionandmanagementof

microcirculatorydysfunctioninsepsispatientsis

crucialforimprovingoutcomesandreducingmortality

Inadditiontothetoolsforassessing

microcirculatorydysfunctioninsepsispatients,there

areseveralotheraspectsofsepsismanagementthat

areimportantforimprovingoutcomesandreducing

mortality.Onekeyaspectisearlyrecognitionand

promptinitiationofappropriateantimicrobialtherapy.

Timelyadministrationofantibioticshasbeenshownto

improvesurvivalinsepsispatients,withahigher

likelihoodofsurvivalwhenantibioticsaregiven

withinthefirsthourofsepsisrecognition.

Anotherimportantaspectofsepsismanagementis

resuscitation,whichincludesfluidtherapyand

vasopressorstooptimizehemodynamicstatus.Earlyand

aggressivefluidresuscitationhasbeenshownto

improveoutcomes,especiallyinpatientswithseptic

shock.However,excessivefluidadministrationcan

leadtofluidoverloadandtissueedema,whichcan

worsenmicrocircu1atorydysfunctionandimpairorgan

function.Therefore,fluidtherapymustbecarefully

titratedaccordingtothepatient'sindividualneeds,

withfrequentreassessmentofhemodynamicstatusand

responsetotherapy.

Aspartofresuscitation,vasopressorssuchas

norepinephrineandvasopressinmaybeusedtomaintain

adequatebloodpressureandorganperfusion.

Vasopressorsshouldbestartedearlyifhypotension

persistsdespiteadequatefluidresuscitation.However,

vasopressorscanalsohaveharmfuleffects,suchas

causingvasoconstrictionandimpairing

microcirculatoryfunction.Therefore,vasopressor

therapymustalsobecarefullytitratedtobalancethe

needformaintainingadequatebloodpressurewiththe

riskofadverseeffectsonmicrocirculation.

Otherimportantaspectsofsepsismanagementinclude

glycemiccontrol,nutritionalsupport,andprevention

ofcomplicationssuchasdeepveinthrombosis,

pressureulcers,andsecondaryinfections.

Additionally,themanagementofsepsisshouldbe

multidisciplinary,involvingateamofhealthcare

professionalssuchascriticalcarephysicians,

infectiousdiseasespecialists,pharmacists,and

nursestoensureoptimalandcoordinatedcare.

Inconclusion,sepsisisacomplexandlife­

threateningconditionthatrequirespromptrecognition

andaggressivetreatment.Microcirculatorydysfunction

isacommonandimportantfeatureofsepsisthatcan

contributetoorgandysfunctionandmortality.Theuse

oftoolssuchastheMFIandSDFimagingcanhelp

identifyandmonitormicrocirculatorydysfunctionin

sepsispatientsandguidetreatmentdecisions.However,

effectivesepsismanagementalsorequirestimely

administrationofappropriate