多普勒鼻烟窝桡动脉阻力指数在脓毒症及感染性休克患者中的应用价值

Application Value of Doppler Sunff-Box Resistive Index in Patients with Sepsis and Septic Shock

摘要: 脓毒症是指因感染引起的宿主反应失调导致的危及生命的器官功能障碍。感染性休克是脓毒症经过充分的液体复苏，仍需使用血管活性药物以维持平均动脉压 ≥ 65 mmHg，且血乳酸浓度 > 2 mmol/L。脓毒症的病理生理核心是微循环功能障碍与血流分布异常。传统宏观血流动力学参数，如平均动脉压、中心静脉压等往往无法准确反映脓毒症患者组织灌注的真实状态。虽然肾动脉阻力指数(Renal Resistive Index, RRI)已被广泛研究作为全身微循环障碍的替代指标，但其测量受多种因素干扰，临床上并不易得。鼻烟窝处的桡动脉位置表浅、易于探测，且远离中心循环，可能比传统宏观血流动力学参数及RRI等指标更能反映外周血管的收缩状态。本研究旨在系统综述多普勒超声测量鼻烟窝桡动脉阻力指数(Doppler Sunff-Box Resistive Index, SBRI)在评估脓毒症及感染性休克患者病情严重程度、预后预测及指导治疗中的临床应用价值。

Abstract: Sepsis refers to life-threatening organ dysfunction caused by dysregulation of the host’s response due to infection. Septic shock is defined as a condition where, after adequate fluid resuscitation, vasopressor drugs are still required to maintain an average arterial pressure of ≥65 mmHg and a blood lactate concentration of >2 mmol/L. The core pathophysiology of sepsis is microcirculation dysfunction and abnormal blood flow distribution. Traditional macroscopic hemodynamic parameters, such as mean arterial pressure and central venous pressure, often fail to accurately reflect the true state of tissue perfusion in sepsis patients. Although Renal Resistive Index (RRI) has been widely studied as an alternative indicator for systemic microcirculation disorders, its measurement is often interfered by various factors and is not easily obtainable in clinical practice. The radial artery position at the naso-gingival area is superficial, easy to detect, and far from the central circulation, and may be more capable of reflecting the contraction state of peripheral blood vessels than traditional macroscopic hemodynamic parameters and RRI and other indicators. This study aims to systematically review the clinical application value of Doppler ultrasound measurement of Doppler Sunff-box Resistive Index (SBRI) in evaluating the severity of sepsis and septic shock patients, predicting prognosis, and guiding treatment.