Characteristics and clinical value of sublingual microcirculation in children with sepsis / 中国小儿急救医学

ABSTRACT

Objective:To investigate the characteristics of sublingual microcirculation in children with sepsis, and to explore the clinical value of sublingual microcirculation in the early diagnosis, therapeutic effect evaluation of sepsis in children.Methods:Children with sepsis and community acquired pneumonia(CAP) admitted in our hospital from December 2018 to December 2019 were included in the study, which was divided into sepsis group and control group(CAP group). In the sepsis group, large circulation indexes and sublingual microcirculation indexes were collected at 0, 6, and 24 hours after admission.Sublingual microcirculation indexes were collected by bypass dark field imaging.In the control group, large circulation indexes were collected after admission, and sublingual microcirculation indexes were collected during tracheal endoscopic examination after sedation.De Backer score(DBs), hetergeneity index(HI), hetergeneity index small(HIs), proportion of pefusedvessels(PPV), proportion of pefused small vessels(PPVs), total of vessel density(TVD), pefused vessel density(PVD), pefused small vessel density(PVDs)were selected as the evaluation index of sublingual microcirculation.The changes of macrocirculation and microcirculation indexes in the two groups were compared, and the correlation between age and microcirculation indexes in the control group was analyzed.Results:A total of 71 children, including 10 sepsis cases and 61 CAP cases, were collected.Among the 61 children with CAP, 9 children (2-48 months) in the same age range as the sepsis group were divided into control group A, and the indicators between the two groups were analyzed.Compared with control group A, PPV and PPVs were lower and DBs, HI, HIs, TVD were higher in the sepsis group at 0 hours( P<0.05). At 6 hours, HI in the sepsis group was still higher than that in control group A, and PPV, PPVs were higher than those at 0 hours.However, at 6 hours, PPVs was still lower than that of control group A( P<0.05), and HI, HIs did not improve compared with those at 0 hours( P>0.05). At 24 hours, HI, PPV and PPVs improved, no difference was found compared with the control group A( P<0.05), while HIs did not improve significantly( P>0.05). The age of the control group had a moderate negative correlation with HI, and a weak negative correlation with HIs( r=-0.420, P=0.001; r=-0.387, P=0.002). Conclusion:HI, HIs, PPV and PPVs are sensitive indexes of microcirculation disorder in children with sepsis.Fluid resuscitation therapy can improve the indexes of sublingual microcirculation in children with sepsis, but the improvement of sublingual microcirculation in children with sepsis is later than the recovery of macro circulation.HI and HIs are negatively correlated with month age in children with CAP.