摘要
急性循环衰竭(acute circulatory failure)最根本的病理生理改变是微循环功能障碍。重要脏器的微循环障碍是急性循环衰竭的必然结果。而急性循环衰竭同时是急危重症患者重要并发症之一,也是ICU患者重要的病亡原因。脓毒症和脓毒性休克是急危重症医学面临的另一重要临床问题,全球每年脓毒症患病人数已超过1900万,其病死率超过1/4,是ICU患者主要病亡原因之一。脓毒症患者病情发展迅速,随着医疗技术的发展,脓毒症患者的病死率虽有下降,但仍处于一个较高水平,尤其是在发展中国家。在脓毒症患者的救治过程中相对于大循环参数,微循环参数能更好预测患者的预后。对成年重症患者进行精准微循环评估是早期发现患者病情变化,识别脓毒症的关键。而以往的微循环评估主要依赖于医生进行血乳酸水平评估,ICU护士24 h在患者床旁,往往能更早地发现患者的病情变化。因此对ICU护士进行微循环评估培训,将微循环评估普及到ICU护士的日常工作中可能对降低重症患者的病死率,改善患者结局有效。然而在国内对重症患者微循环的护理评估并没有普及到护士日常工作中,也没有统一的评估手段与策略。因此对国内外常用的微循环评估手段进行总结,旨在为ICU护士选择合适的评估重症患者微循环的工具与手段,并为制订微循环评估管理流程提供参考。
Objective The most fundamental pathophysiological change in acute circulatory failure(ACF)is microcirculatory dysfunction.Microcirculatory dysfunction in major organs is the inevitable consequence of acute circulatory failure.Acute circulatory failure is one of the most important complications and critical illnesses and a major cause of death in intensive care patients.Sepsis and septic shock is another important clinical problem in acute and critical care medicine,the number of patients with sepsis has exceeded 19 million per year worldwide,the mortality rate is more than 1/4,which is one of the major causes of death in ICU patients.With the development of medical technology,though there was a decreasing trend,the mortality rate of sepsis patients is still high,especially in developing countries.Microcirculatory parameters are better predictors of patient prognosis than macrocirculatory parameters in the management of sepsis patients.Accurate microcirculatory assessment in adult critically ill patients is key to early detection of changes in patient status and identification of sepsis.While microcirculatory assessment has traditionally relied on physicians to assess blood lactate levels,ICU nurses accompany the patients 24 h,to detect changes in the patient's condition earlier.Therefore,training ICU nurses in microcirculation assessment and popularising microcirculation assessment in ICU nurses'daily work may be effective in reducing morbidity and mortality of critically ill patients and improving patient outcomes.Domestic nursing assessment of microcirculation in critically ill patients has not been popularised in nurses'daily work,and there are no uniform assessment tools and strategies.To summarise the commonly used microcirculation assessment tools at home and abroad,to select appropriate tools and instruments for ICU nurses to assess microcirculation in critically ill patients,to provide a reference for the development of microcirculation assessment and management process.
作者
王海萌
倪明昊
王岚
班相青
宋润珞
WANG Haimeng;NI Minghao;WANG Lan;BAN Xiangqing;SONG Runluo(Nursing School of Henan Technology University,Luoyang 471000,China;Hebei People’s Hospital,Shijiazhuang 050051,China;Firtst Affiliated Hospital of Henan Technology University,Luoyang 471003,China)
出处
《护理实践与研究》
2025年第6期881-887,共7页
Nursing Practice and Research
基金
河北省卫生健康委医学科学研究课题计划(编号:20242097)。
关键词
微循环
外周灌注
重症监护室
脓毒症
护理评估
Microcirculation
Peripheral perfusion
Intensive care unit
Sepsis
Nursing assessment
