背景:毛细管再填充时间(CRT)定义为在施加压力以引起烫漂之后颜色返回到外部毛细管床所花费的时间。最近的研究证明了CRT在指导败血症的液体治疗中的益处。然而,医生在如何执行和解释CRT方面缺乏一致性,导致观察者对该评估工具的共识较低,这阻止了它在脓毒症临床环境中的可用性。
目的:给医生一个简明的CRT概述,并探讨其在脓毒症管理中的可靠性和价值的最新证据。
方法:叙述性回顾。
结果:这篇叙述性综述总结了影响CRT值的因素,例如,年龄,性别,温度,光,观测技术,工作经验,训练水平和CRT测量方法的差异。合成了降低CRT变异性的方法。基于具有高度可重现性的CRT测量和出色的评分者间一致性的研究,我们推荐标准化的CRT评估方法.讨论了正常CRT值的阈值。总结了CRT在脓毒症管理不同阶段的应用。
结论:最近的数据证实了CRT在危重患者中的价值。CRT应由训练有素的医生使用标准化方法检测,并减少环境相关因素的影响。它与严重感染有关,微循环,组织灌注反应,器官功能障碍和不良后果使这种方法成为脓毒症非常有吸引力的工具.进一步的研究应证实其在脓毒症管理中的价值。
结论:作为一个简单的评估,尽管CRT尚未在床边广泛应用,但仍值得更多关注。CRT可以为护理人员提供患者的微循环状态,这可能有助于制定个性化护理计划,提高患者的护理质量和治疗效果。
BACKGROUND: Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. Recent studies demonstrated the benefits of CRT in guiding fluid therapy for sepsis. However, lack of consistency among physicians in how to perform and interpret CRT has led to a low interobserver agreement for this assessment tool, which prevents its availability in sepsis clinical settings.
OBJECTIVE: To give physicians a concise overview of CRT and explore recent evidence on its reliability and value in the management of sepsis.
METHODS: A narrative review.
RESULTS: This narrative review summarizes the factors affecting CRT values, for example, age, sex, temperature, light, observation techniques, work experience, training level and differences in CRT measurement methods. The methods of reducing the variability of CRT are synthesized. Based on studies with highly reproducible CRT measurements and an excellent inter-rater concordance, we recommend the standardized CRT assessment method. The threshold of normal CRT values is discussed. The application of CRT in different phases of sepsis management is summarized.
CONCLUSIONS: Recent data confirm the value of CRT in critically ill patients. CRT should be detected by trained physicians using standardized methods and reducing the effect of ambient-related factors. Its association with severe infection, microcirculation, tissue perfusion response, organ dysfunction and adverse outcomes makes this approach a very attractive tool in sepsis. Further studies should confirm its value in the management of sepsis.
CONCLUSIONS: As a simple assessment, CRT deserves more attention even though it has not been widely applied at the bedside. CRT could provide nursing staff with patient\'s microcirculatory status, which may help to develop individualized nursing plans and improve the patient\'s care quality and treatment outcomes.