Abstract：Microcirculatory lesions are the key link leading to tissue hypoperfusion. Monitoring of microcirculatory lesions is very important in severe diseases. The tongue body is rich in microvessels, in which the sublingual microcirculation presents a reticular structure, reflecting the state of microcirculation in living tissue, and is an ideal and important site for clinical microcirculation monitoring and microcirculation detection in living animals. The equipment, index system, application, clinical significance and future prospect of sublingual microcirculation microimage monitoring were reviewed in this article. Firstly, we introduced the monitoring equipment, including the composition of the equipment, the types of optical technology adopted by the probe, the image processing algorithm adopted by the host, and the fixed form of the probe. Secondly, the index system of sublingual microcirculation microimage monitoring was summarized, including the perfusion quality index, vascular density index and perfusion heterogeneity index. Next, an example was given to illustrate the clinical and experimental applications, including the study on the relationship between diseases and microcirculation in clinical practice, the study on the relationship between drugs and microcirculation, and the study on the relationship between visceras' microcirculation using sublingual microcirculation microimage monitoring technology. Finally, the significance of clinical diagnosis, treatment and research were discussed, and the technical improvement, development and application direction are prospected.
蒋升, 李佩伦, 宁钢民. 舌下微循环显微影像监测及其应用研究进展[J]. 中国生物医学工程学报, 2021, 40(1): 99-106.
Jiang Sheng, Li Peilun, Ning Gangmin. Progress of Sublingual Microcirculation Microimage Monitoring and Application. Chinese Journal of Biomedical Engineering, 2021, 40(1): 99-106.
[1] Lush CW, Kvietys PR. Microvascular dysfunction in sepsis[J]. Microcirculation, 2000, 7(2): 83-101. [2] Domizi R, Damiani E, Scorcella C, et al. Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study.[J]. PLoS ONE, 2019, 14(3): e0213085. [3] Cavazzoni SLZ, Dellinger RP. Hemodynamic optimization of sepsis-induced tissue hypoperfusion[J]. Critical Care, 2006, 10(3 Supplement): S2. [4] Zhao X, Niu T, Wei A. Image analysis of microvessel and perivascular tissues of the lingual papilla and observation of tissue channel[J]. Chinese Journal of Microcirculation, 2007, 17(1): 24-25. [5] Cerny V. Sublingual microcirculation[J]. Applied Cardiopulmonary Pathophysiology, 2012, 16(3): 229-248. [6] Hessler M, Arnemann PH, Zamit F, et al. Monitoring of conjunctival microcirculation reflects sublingual microcirculation in ovine septic and hemorrhagic shock[J]. Shock, 2018, 51(4): 479-486. [7] Lush CW, Kvietys PR. Microvascular dysfunction in sepsis[J]. Microcirculation, 2015, 7(2): 83-101. [8] Liu J, Wang H, Qi Z. Effect of propofol on sublingual microcirculation in patients with septic shock[J]. Journal of Medical Research, 2015, 44(10): 57-59. [9] Nakagawa Y, Weil M, Tang W, et al. Sublingual capnometry for diagnosis and quantitation of circulatory shock[J]. American Journal of Respiratory and Critical Care Medicine, 1998, 157(6): 1838-1843. [10] Groner W, Winkelman JW, Harris AG, et al. Orthogonal polarization spectral imaging: a new method for study of the microcirculation[J]. Nature Medicine, 1999, 5(10): 1209-1212. [11] Goedhart PT, Khalilzada M, Bezemer R, et al. Sidestream dark field (SDF) imaging: A novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express[J]. Optics Express, 2007, 15(23): 101-114. [12] Micro vision medical [EB/OL]. https://www.microvisionmedical. com, 2020/2020-12-24. [13] KK Technology [EB/OL]. http://www.kktechnology.com, 2019-08-16/2020-12-24. [14] Aykut G, Veenstra G, Scorcella C, et al. Cytocam-IDF (incident dark field illumination) imaging for bedside monitoring of the microcirculation[J]. Intensive Care Medicine Experimental, 2015, 3(1): 1-10. [15] Sherman H, Klausner S, Cook WA. Incident dark-field illumination: a new method for microcirculatory study[J]. Angiology, 1971, 22(5): 295-303. [16] Copel J, Bountziouka V, Ince C, et al. A comparison of the quality of image acquisition between the incident dark field and sidestream dark field video-microscopes[J]. BMC Medical Imaging, 2016, 16(1): 10. [17] Elteren HAV, Ince C, Tibboel D, et al. Cutaneous microcirculation in preterm neonates: comparison between sidestream dark field (SDF) and incident dark field (IDF) imaging[J]. Journal of Clinical Monitoring and Computingvolume, 2015, 15(4): 130-131. [18] Braedius medical [EB/OL]. https://braedius-medical.com, 2018-08-13/2020-12-24. [19] Bezemer R, Dobbe JG, Bartels SA, et al. Rapid automatic assessment of microvascular density in sidestream dark field images[J]. Medical & Biological Engineering & Computing, 2011, 49(11): 1269-1278. [20] 吕菲. 基于视频图像的微循环血流分析系统的研制[D]. 南京:东南大学, 2015. [21] Kuryati K, Enamul HM, Thai LL, et al. A review on the extraction of quantitative retinal microvascular image feature[J]. Computational & Mathematical Methods in Medicine, 2018, 2018: 4019538. [22] Mcgarr GW, Hodges GJ, Cheung SS. An adjustable stabilizing device for imaging the cutaneous microcirculation with Sidestream Dark Field imaging[J]. Microvascular Research, 2015, 100: 1-3. [23] Balestra GM, Bezemer R, Boerma EC, et al. Improvement of sidestream dark field imaging with an image acquisition stabilizer[J]. BMC Medical Imaging, 2010, 10(1): 15. [24] De Bruin AFJ, Tavy A, Koene VDS, et al. Use of an image acquisition stabilizer improves Sidestream Dark Field imaging of the serosa during open gastrointestinal surgery[J]. Journal of Vascular Research, 2016, 53(3-4): 121-127. [25] Ince C. Boerma EC, Cecconi M, et al. Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine[J]. Intensive Care Med, 2018, 44(10): 1-19. [26] Ince C, The Microcirculation in the motor of sepsis[J]. Critical Care 2005, 9(suppl 4): S13-S19 [27] Rovas A, Seidel LM, Vink H, et al. Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis[J]. Critical Care, 2019, 23(1):260. [28] Ospina-Tascon G, Neves AP, Occhipinti G, et al. Effects of fluids on microvascular perfusion in patients with severe sepsis[J]. Intensive Care Med, 2010, 36(6): 949-955. [29] Ballerga EG, Pozo MO, Birri PNR, et al. Sublingual microcirculatory alterations in cirrhotic patients[J]. Microcirculation, 2018, 25(4): e12448. [30] 赵川, 林兆奋, 马林浩. 不同低温目标温度对于心肺复苏猪模型舌下和大脑微循环的影响[J]. 临床急诊杂志, 2019, 20(8): 607-611. [31] Uz Z, de Mol BA, van Gulik TM, et al. Sublingual microcirculation reveals fluid overload and leukocytosis in a post-cardiac surgery patient[J]. Bmj Case Reports, 2018, 2018: bcr-2017-223681. [32] Spronk PE, Ince C, Gardien MJ, et al. Nitroglycerin in septic shock after intravascular volume resuscitation[J]. Lancet, 2002, 360 (9343): 1395-1396. [33] Boerma EC, Koopmans M, Konijn A, et al. Effects of nitroglycerin on sublingual microcirculatory blood flow in patients with severe sepsis/septic shock after a strict resuscitation protocol: A double-blind randomized placebo controlled trial[J]. Critical Care Medicine, 2010, 38(1): 93-100. [34] Gertler R, Brown HC, Mitchell DH, et al. Dexmedetomidine: a novel sedative-analgesic agent[J]. Bumc Proc, 2017, 14(1): 13-21. [35] Hisham H, Hassan M, Pierre T, et al. Effect of dexmedetomidine infusion on sublingual microcirculation in patients undergoing on pump coronary artery bypass graft surgery. A prospective rondomised trial[J]. Journal of Cardiothoracic & Vascular Anesthesia, 2019,33(2):334-340. [36] Mebazaa, Alexandre, Nieminen, et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure[J]. Jama, 2007, 13(4): 240-241. [37] Hernandez G, Bruhn A, Luengo C, et al. Effects of dobutamine on systemic, regional and microcirculatory perfusion parameters in septic shock: A randomized, placebo-controlled, double-blind, crossover study[J]. Intensive Care Medicine, 2013, 39(8): 1435-1443. [38] Kalmar AF, Silvie A, Pletinckx P, et al. Phenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension[J]. Journal of Clinical Monitoring & Computing, 2018, 32(6): 1-8. [39] Maier S, Hasibeder WR, Hengl C, et al. Effects of phenylephrine on the sublingual microcirculation during cardiopulmonary bypass[J]. British Journal of Anaesthesia, 2009, 102(4): 485-491. [40] Morelli A, Ertmer C, Rehberg S, et al. Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): A randomized, controlled pilot study[J]. Critical Care (BioMed Central), 2009, 13(4): R130. [41] Morelli A, Donati A, Ertmer C, et al. Effects of vasopressinergic receptor agonists on sublingual microcirculation in norepinephrine-dependent septic shock[J]. Critical Care, 2011, 15(5): R217. [42] Qian J, Yang Z, Cahoon J, et al. Post-resuscitation intestinal microcirculation: Its relationship with sublingual microcirculation and the severity of post-resuscitation syndrome [J]. Resuscitation, 2014, 85(6): 833-839. [43] 刘威, 段美丽, 翁以炳, 等. 脓毒症猪舌下微循环与肠系膜微循环关系的实验研究[J]. 中国急救医学, 2017, 37(11): 977-983. [44] Boerma EC, Van VP, Spronk PE, et al. Relationship between sublingual and intestinal microcirculatory perfusion in patients with abdominal sepsis[J]. Critical Care Medicine, 2007, 35(4): 1055-1060. [45] Trzeciak S, Mccoy JV, Dellinger RP, et al. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24h in patients with sepsis[J]. Intensive Care Medicine,2008,34(12):2210-2217. [46] Scheuzger JD, Zehnder A, Yeginsoy D, et al. Sublingual microcirculation: A case report[J]. Journal of Medical Case Reports,2019,13(1):179-179. [47] Caixeta DM, Fialho FM, Azevedo ZM, et al. Evaluation of sublingual microcirculation in children with dengue shock.[J]. Clinics,2013,68(7):1061-1064. [48] Bouattour K, Teboul J, Varin L, et al. Preload dependence is associated with reduced sublingual microcirculation during major abdominal surgery[J]. Anesthesiology,2019,130(4):541-549. [49] Ferrara G, Kanoore Edul VS, Martins E, et al. Intestinal and sublingual microcirculation are more severely compromised in hemodilution than in hemorrhage[J]. Journal of Applied Physiology,2016,120(10):2007-2016. [50] 高飞,傅小云,钱明江,等. 侧流暗场成像技术观察内毒素休克兔小肠绒毛与舌下微循环改变[J]. 中国病理生理杂志, 2017, 33(4): 764-768. [51] 赵川, 林兆奋, 马林浩. 不同低温目标温度对于心肺复苏猪模型舌下和大脑微循环的影响[J]. 临床急诊杂志, 2019, 20(8): 607-611.
