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Article(id=1320441064457089769, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1320441063936996073, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202510092, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764000000000, receivedDateStr=2025-11-25, revisedDate=1770739200000, revisedDateStr=2026-02-11, acceptedDate=null, acceptedDateStr=null, onlineDate=1792747282375, onlineDateStr=2026-10-23, pubDate=1776182400000, pubDateStr=2026-04-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792747282375, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792747282375, creator=13701087609, updateTime=1792747282375, updator=13701087609, issue=Issue{id=1320441063936996073, tenantId=1146029695717560320, journalId=1319373162502258839, year='2026', volume='48', issue='7', pageStart='831', pageEnd='970', issueExtLink='null', onlineDate='null', pubDate='1776182400000', pubDateStr='2026-04-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792747282251, creator='13701087609', updateTime=1792749796678, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320451610262745636, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1320441063936996073, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320451610262745637, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1320441063936996073, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=895, endPage=904, ext={EN=ArticleExt(id=1320441064717136618, articleId=1320441064457089769, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Development and validation of a novel tertiary quantitative assessment for hemorrhagic shock: an integrated study based on Delphi method and SDF microcirculation imaging technology, columnId=1320435151990014650, journalTitle=Journal of Army Medical University, columnName=Military Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective

Traditional hemorrhagic shock (HS) assessment methods focus solely on macrocirculatory indicators, failing to detect microcirculatory disturbances at an early stage, which may lead to misjudgment of disease severity or delayed intervention. This randomized controlled animal experimental study aims to construct a novel three-level quantitative assessment integrating basic vital signs, blood gas indicators, and microcirculatory parameters, to determine its accuracy and reliability in distinguishing mild, moderate, and severe HS, thereby providing a scientific tool for early precise staging and targeted resuscitation in clinical practice.

Methods

Following the quality control principles of experimental research (randomization, blinded assessment), 20 experts with associate senior professional titles or above in the fields of anesthesiology, critical care medicine, field surgery and other relevant disciplines were selected to conduct 3 rounds of anonymous Delphi consultations. Shock evaluation indicators were screened and their weights were determined by calculating the expert positive coefficient, opinion concentration degree and opinion coordination degree. A three-level assessment system consisting of basic vital signs, blood gas indicators and microcirculatory parameters was constructed, and quantitative scoring standards were formulated. A total of 64 SPF-grade SD rats (12 weeks old) were randomly divided into 4 groups (n=16): a sham operation group and mild, moderate, and severe HS groups (with blood loss accounting for 20%, 35% and 50% of total blood volume, respectively). Side stream dark-field (SDF) microcirculation imaging was employed to detect microcirculatory indicators, and mean arterial pressure (MAP) and oxygen saturation were recorded simultaneously to validate the accuracy of the assessment method.

Results

The positive coefficients (100.0%, 100.0%, 88.9%) and coordination coefficients (Kendall's W increased from 0.144 to 0.444, P<0.05) of the 3 rounds of expert consultations were relatively high, with a coefficient of variation ranging from 0.07 to 0.27, indicating a significant improvement in the consistency of expert opinions. Finally, 5 core secondary indicators were identified, with their weights as follows: perfused vessel density (0.138 8), MAP (0.131 8), oxygen saturation (0.129 9), microvascular flow index (0.128 1) and perfused vessel proportion (0.126 3). The quantitative scoring standard showed that 5 to 10 points indicated mild HS, 11 to 15 points moderate, and 16-20 points severe. In animal experimental validation, the accuracy of this method in distinguishing mild, moderate and severe HS was 93.75% (95%CI: 71.7% to 98.9%), 93.75% (95%CI: 71.7% to 98.9%) and 100% (95%CI: 83.8% to 100%), respectively.

Conclusion

Our novel quantitative HS assessment tool based on SDF technology and Delphi method, can accurately distinguish HS of different severity levels (accuracy rate >90%), effectively integrate the monitoring dimensions of macrocirculation, oxygenation, and microcirculation. Our tool addresses the limitation of traditional assessment tools in neglecting microcirculation, providing reliable assessment for early precise identification, dynamic monitoring of disease progression, and targeted resuscitation of HS, with significant potential for clinical translation.

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目的

传统失血性休克评估方法仅聚焦于宏观循环指标，无法早期捕捉微循环障碍，易导致病情误判或干预延误。本研究采用随机对照动物实验研究设计，旨在构建一套整合基本生命指标、血气指标及微循环指标的三级量化评估新方法，明确其区分轻、中、重度失血性休克的准确性及可靠性，为临床早期精准分期与针对性复苏提供科学工具。

方法

本研究遵循实验性研究的质量控制原则（随机化、盲法评估），遴选麻醉、重症、野战外科等领域20名副高级及以上职称专家，采用3轮德尔菲法匿名函询。通过计算专家积极系数、意见集中程度、协调程度筛选休克评估指标并确定权重；构建基本生命指标、血气指标、微循环指标三级评估体系，制定量化评分标准；将64只12周龄SPF级SD大鼠按随机数字法分为4组（n=16）：假手术组及轻、中、重度失血性休克组（失血量分别为总血容量20%、35%、50%），采用侧流暗场（side stream dark-field，SDF）微循环成像技术检测微循环指标，同步记录平均动脉压（mean arterial pressure，MAP）、氧饱和度，验证评估方法的准确率。

结果

3轮专家咨询的积极系数（100.0%、100.0%、88.9%）和协调系数（Kendall’s W从0.144升至0.444，P<0.05）均较高，变异系数范围为0.07~0.27，提示专家意见一致性显著提升；最终确定5个核心二级指标，其权重分别为：灌注血管密度0.1388、MAP 0.131 8、氧饱和度0.129 9、微血管流动指数0.128 1、灌注血管比例0.126 3。量化评分标准显示：5~10分为轻度失血性休克，11~15分为中度失血性休克，16~20分为重度失血性休克；动物实验验证中，该方法区分轻度、中度、重度失血性休克的准确率分别为93.75%（95%CI：71.7%~98.9%）、93.75%（95%CI：71.7%~98.9%）、100%（95%CI：83.8%~100%）。

结论

本研究构建的基于SDF技术与德尔菲法量化休克评估新方法，可精准区分不同严重程度失血性休克（准确率>90%），有效整合宏观循环、氧合与微循环监测维度，解决了传统评估方法轻微观的局限性，为失血性休克的早期精准识别、病情动态监测和针对性复苏提供了可靠的评估工具，具有重要的临床转化潜力。

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李涛，E-mail：
LI Tao，E-mail：
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Andes Pediatrica： Revista Chilena De Pediatria， 2024， 95（2）： 202~212., articleTitle=［Tissue perfusion monitoring in children with acute circulatory dysfunction： narrative review］, refAbstract=null), Reference(id=1320441071151199035, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, doi=10.1097/CM9. 0000000000000887, pmid=null, pmcid=null, year=2020, volume=133, issue=18, pageStart=2153, pageEnd=2160, url=null, language=null, rfNumber=24, rfOrder=30, authorNames=ZHANG H, LI L, WU J, journalName=Chin Med J, refType=null, unstructuredReference=ZHANG H， LI L， WU J， et al. Time of dissociation between microcirculation， macrocirculation， and lactate levels in a rabbit model of early endotoxemic shock［J］. Chin Med J， 2020， 133（18）： 2153-2160., articleTitle=Time of dissociation between microcirculation， macrocirculation， and lactate levels in a rabbit model of early endotoxemic shock, refAbstract=null), Reference(id=1320441071394468668, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, doi=10.1097/ACO. 0000000000000957, pmid=null, pmcid=null, year=2021, volume=34, issue=2, pageStart=85, pageEnd=91, url=null, language=null, rfNumber=25, rfOrder=31, authorNames=DE BACKER D, RICOTTILLI F, OSPINA-TASCÓN G A, journalName=Curr Opin Anaesthesiol, refType=null, unstructuredReference=DE BACKER D， RICOTTILLI F， OSPINA-TASCÓN G A. Septic shock： a microcirculation disease［J］. Curr Opin Anaesthesiol， 2021， 34（2）： 85-91., articleTitle=Septic shock： a microcirculation disease, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1320441065555997422, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, xref=1, ext=[AuthorCompanyExt(id=1320441065564386031, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, companyId=1320441065555997422, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Shock and Transfusion， State Key Laboratory of Trauma and Chemical Poisoning， Daping Hospital， Army Medical University （Third Military Medical University）， Chongqing， China), AuthorCompanyExt(id=1320441065572774640, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, companyId=1320441065555997422, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1陆军军医大学大坪医院战伤休克与输血研究室，创伤与化学中毒全国重点实验室，重庆)])], figs=[ArticleFig(id=1320441067338576653, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=EN, label=Figure 1, caption=Scores of our new SDF-based assessment tool for different degrees of hemorrhagic shock （HS） （n=16）, figureFileSmall=UC1AmRm44IGh9NWOXhNB0Q==, figureFileBig=cZrKHq2JPKHAYqRmhhTD+g==, tableContent=null), ArticleFig(id=1320441067409879822, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=CN, label=图1, caption=基于 SDF 评估失血性休克的新方法对不同失血性休克程度的评分（n=16）

A： mean arterial pressure （MAP） in different severity of HS； B： oxygen saturation （SO2） in different severity of HS； C： perfused vessel density in different severity of HS； D： perfused vessel proportion in different severity of HS； E： microvascular flow index in different severity of HS； F： total scores of our new assessment tool for different severity of HS

, figureFileSmall=UC1AmRm44IGh9NWOXhNB0Q==, figureFileBig=cZrKHq2JPKHAYqRmhhTD+g==, tableContent=null), ArticleFig(id=1320441067695092495, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=EN, label=Table 1, caption=

Hemorrhagic shock （HS） assessment indicator system constructed based on Delphi method

, figureFileSmall=null, figureFileBig=null, tableContent=
First-level indicatorsSecond-level indicators
Basic vital signsShock index， mean arterial pressure， heart rate， urine output， respiration， mental state， capillary refill
Blood gas indicatorsPartial pressure of oxygen， partial pressure of carbon dioxide， oxygen saturation， pH value， base deficit， blood lactic acid
Microcirculation indicatorsPerfused vessel density， perfused vessel proportion， total vessel density， microvascular flow index， heterogeneity index
), ArticleFig(id=1320441067778978576, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=CN, label=表1, caption=

基于德尔菲法构建的失血性休克评估指标体系

, figureFileSmall=null, figureFileBig=null, tableContent=
First-level indicatorsSecond-level indicators
Basic vital signsShock index， mean arterial pressure， heart rate， urine output， respiration， mental state， capillary refill
Blood gas indicatorsPartial pressure of oxygen， partial pressure of carbon dioxide， oxygen saturation， pH value， base deficit， blood lactic acid
Microcirculation indicatorsPerfused vessel density， perfused vessel proportion， total vessel density， microvascular flow index， heterogeneity index
), ArticleFig(id=1320441067862864657, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=EN, label=Table 2, caption=

Basic information of the expert consultation group （n=20）

, figureFileSmall=null, figureFileBig=null, tableContent=
CategoryNumberPercentage/%
Age/years
30 to 4015.00
41 to 50630.00
51 to 601260.00
>6015.00
Professional title
Senior title1680.00
Associate senior title420.00
Years of experience/ years
10 to 20525.00
21 to 301050.00
>30525.00
Professional field
Field surgery210.00
Critical care medicine210.00
Trauma， anesthesiology， emergency medicine， etc.1680.00
), ArticleFig(id=1320441067959333650, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=CN, label=表2, caption=

咨询专家小组基本情况表（n=20）

, figureFileSmall=null, figureFileBig=null, tableContent=
CategoryNumberPercentage/%
Age/years
30 to 4015.00
41 to 50630.00
51 to 601260.00
>6015.00
Professional title
Senior title1680.00
Associate senior title420.00
Years of experience/ years
10 to 20525.00
21 to 301050.00
>30525.00
Professional field
Field surgery210.00
Critical care medicine210.00
Trauma， anesthesiology， emergency medicine， etc.1680.00
), ArticleFig(id=1320441068039025427, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=EN, label=Table 3, caption=

Concentration and coordination of expert opinions in consultations

, figureFileSmall=null, figureFileBig=null, tableContent=
RoundAverage scoreStandard deviationCoefficient of variationKendall’s Wχ2P
2nd3.78－4.890.32－1.210.07－0.320.14416.167<0.001
3rd4.56－4.880.34－1.060.07－0.270.44487.8950.024
), ArticleFig(id=1320441068139688724, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=CN, label=表3, caption=

咨询的专家意见集中程度和协调程度

, figureFileSmall=null, figureFileBig=null, tableContent=
RoundAverage scoreStandard deviationCoefficient of variationKendall’s Wχ2P
2nd3.78－4.890.32－1.210.07－0.320.14416.167<0.001
3rd4.56－4.880.34－1.060.07－0.270.44487.8950.024
), ArticleFig(id=1320441068210991893, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=EN, label=Table 4, caption=

Importance of secondary indicators in the first round of expert consultation

, figureFileSmall=null, figureFileBig=null, tableContent=
Second-level indicatorsImportance/%
Basic vital signs
Shock index30.00
MAP20.25
Heart rate9.00
Urine output8.00
Respiration8.00
Mental state12.75
Capillary refill12.00
Microcirculation indicators
Perfused vessel density26.75
Perfused vessel proportion33.25
Total vessel density12.75
Microvascular flow index17.25
Heterogeneity index10.00
Blood gas indicators
Partial pressure of oxygen15.25
Partial pressure of carbon dioxide10.50
Oxygen saturation36.00
pH value11.00
Base deficit6.50
Blood lactic acid20.75
), ArticleFig(id=1320441068294877974, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=CN, label=表4, caption=

第1轮专家咨询基于SDF的休克评估新方法各二级指标重要程度

, figureFileSmall=null, figureFileBig=null, tableContent=
Second-level indicatorsImportance/%
Basic vital signs
Shock index30.00
MAP20.25
Heart rate9.00
Urine output8.00
Respiration8.00
Mental state12.75
Capillary refill12.00
Microcirculation indicators
Perfused vessel density26.75
Perfused vessel proportion33.25
Total vessel density12.75
Microvascular flow index17.25
Heterogeneity index10.00
Blood gas indicators
Partial pressure of oxygen15.25
Partial pressure of carbon dioxide10.50
Oxygen saturation36.00
pH value11.00
Base deficit6.50
Blood lactic acid20.75
), ArticleFig(id=1320441068374569751, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=EN, label=Table 5, caption=

Importance of secondary indicators in the second round of expert consultation［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
Second-level indicatorsNumber
Very importantImportantModerateUnimportantVeryunimportant
Basic vital signs
Shock index		15（83.3）3000
MAP16（88.9）2000
Urine output10（55.6）44（22.2）00
Mental state8（44.4）73（16.7）00
Capillary refill14（77.8）22（11.1）00
Blood gas indicators
Partial pressure of oxygen		10（55.6）25（27.8）1（5.5）0
Oxygen saturation16（88.9）2000
pH value8（44.4）16（33.3）3（16.7）0
Blood lactic acid12（66.7）33（16.7）00
Microcirculation indicators
Perfused vessel density		14（77.8）13（16.7）00
Perfused vessel proportion15（83.4）21（5.5）00
Microvascular flow index13（72.2）23（16.7）00
), ArticleFig(id=1320441068466844440, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=CN, label=表5, caption=

基于SDF评估休克新方法的二级评估指标第2轮专家咨询重要程度［例（％）］

, figureFileSmall=null, figureFileBig=null, tableContent=
Second-level indicatorsNumber
Very importantImportantModerateUnimportantVeryunimportant
Basic vital signs
Shock index		15（83.3）3000
MAP16（88.9）2000
Urine output10（55.6）44（22.2）00
Mental state8（44.4）73（16.7）00
Capillary refill14（77.8）22（11.1）00
Blood gas indicators
Partial pressure of oxygen		10（55.6）25（27.8）1（5.5）0
Oxygen saturation16（88.9）2000
pH value8（44.4）16（33.3）3（16.7）0
Blood lactic acid12（66.7）33（16.7）00
Microcirculation indicators
Perfused vessel density		14（77.8）13（16.7）00
Perfused vessel proportion15（83.4）21（5.5）00
Microvascular flow index13（72.2）23（16.7）00
), ArticleFig(id=1320441068559119129, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=EN, label=Table 6, caption=

Weight analysis of secondary indicators in the third round of expert consultation

, figureFileSmall=null, figureFileBig=null, tableContent=
Second-level indicatorsNumber（subtotal）Total scoreWeight value
Very importantImportantModerateUnimportantVery unimportant
54321
Basic vital signs
Shock index		8（40）6（24）1（3）00700.124 6
MAP12（60）2（8）2（6）00740.131 8
Capillary refill6（30）2（8）7（21）1（2）0610.108 5
Blood gas indicators
Oxygen saturation		11（55）3（12）2（6）00730.129 9
Blood lactic acid6（30）5（20）3（9）2（4）0630.112 1
Microcirculation indicators
Perfused vessel density		14（70）2（8）000780.138 8
Perfused vessel proportion10（50）3（12）3（9）00710.126 3
Microvascular flow index9（45）6（24）1（3）00720.128 1
), ArticleFig(id=1320441068651393818, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=CN, label=表6, caption=

基于SDF评估休克新方法二级评估指标第3轮专家咨询结果权重分析

, figureFileSmall=null, figureFileBig=null, tableContent=
Second-level indicatorsNumber（subtotal）Total scoreWeight value
Very importantImportantModerateUnimportantVery unimportant
54321
Basic vital signs
Shock index		8（40）6（24）1（3）00700.124 6
MAP12（60）2（8）2（6）00740.131 8
Capillary refill6（30）2（8）7（21）1（2）0610.108 5
Blood gas indicators
Oxygen saturation		11（55）3（12）2（6）00730.129 9
Blood lactic acid6（30）5（20）3（9）2（4）0630.112 1
Microcirculation indicators
Perfused vessel density		14（70）2（8）000780.138 8
Perfused vessel proportion10（50）3（12）3（9）00710.126 3
Microvascular flow index9（45）6（24）1（3）00720.128 1
), ArticleFig(id=1320441068722696987, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=EN, label=Table 7, caption=

Scoring table for the severity of shock

, figureFileSmall=null, figureFileBig=null, tableContent=
Second-level indicatorsScore （coefficient）
Normal（score=1）Mild shock（score=2）Moderate shock（score=3）Severe shock（score=4）
Map/mmhg>10071‒10040‒70<40
Oxygen saturation/%>9580‒9470‒79<70
Perfused vessel density/mm·mm-215‒2012‒149‒11<9
Perfused vessel proportion/%85‒10070‒8455‒69<55
Microvascular flow index2‒31.5‒2.01.0‒1.5<1
Total score <5： normal； 5‒10： mild shock； 11‒15： moderate shock； 16‒20： severe shock
), ArticleFig(id=1320441068789805852, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320441064457089769, language=CN, label=表7, caption=

基于SDF评估新方法对休克严重程度的评分表

, figureFileSmall=null, figureFileBig=null, tableContent=
Second-level indicatorsScore （coefficient）
Normal（score=1）Mild shock（score=2）Moderate shock（score=3）Severe shock（score=4）
Map/mmhg>10071‒10040‒70<40
Oxygen saturation/%>9580‒9470‒79<70
Perfused vessel density/mm·mm-215‒2012‒149‒11<9
Perfused vessel proportion/%85‒10070‒8455‒69<55
Microvascular flow index2‒31.5‒2.01.0‒1.5<1
Total score <5： normal； 5‒10： mild shock； 11‒15： moderate shock； 16‒20： severe shock
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失血性休克三级量化评估新方法的构建与验证：基于德尔菲法与SDF微循环成像技术的整合研究
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朱娱 , 吴跃 , 李清晖 , 李涛
陆军军医大学学报 | 论著·军事医学 2026,48(7): 895-904
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陆军军医大学学报 |论著·军事医学 2026 , 48 (7) : 895 -904
失血性休克三级量化评估新方法的构建与验证：基于德尔菲法与SDF微循环成像技术的整合研究
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朱娱, 吴跃, 李清晖, 李涛
作者信息
  • 1陆军军医大学大坪医院战伤休克与输血研究室，创伤与化学中毒全国重点实验室，重庆
通讯作者:
李涛，E-mail：
LI Tao，E-mail：
Development and validation of a novel tertiary quantitative assessment for hemorrhagic shock: an integrated study based on Delphi method and SDF microcirculation imaging technology
Yu ZHU, Yue WU, Qinghui LI, Tao LI
Affiliations
  • 1Department of Shock and Transfusion， State Key Laboratory of Trauma and Chemical Poisoning， Daping Hospital， Army Medical University （Third Military Medical University）， Chongqing， China
出版时间: 2026-04-15 doi: 10.16016/j.2097-0927.202510092
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摘要
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目的

传统失血性休克评估方法仅聚焦于宏观循环指标，无法早期捕捉微循环障碍，易导致病情误判或干预延误。本研究采用随机对照动物实验研究设计，旨在构建一套整合基本生命指标、血气指标及微循环指标的三级量化评估新方法，明确其区分轻、中、重度失血性休克的准确性及可靠性，为临床早期精准分期与针对性复苏提供科学工具。

方法

本研究遵循实验性研究的质量控制原则（随机化、盲法评估），遴选麻醉、重症、野战外科等领域20名副高级及以上职称专家，采用3轮德尔菲法匿名函询。通过计算专家积极系数、意见集中程度、协调程度筛选休克评估指标并确定权重；构建基本生命指标、血气指标、微循环指标三级评估体系，制定量化评分标准；将64只12周龄SPF级SD大鼠按随机数字法分为4组（n=16）：假手术组及轻、中、重度失血性休克组（失血量分别为总血容量20%、35%、50%），采用侧流暗场（side stream dark-field，SDF）微循环成像技术检测微循环指标，同步记录平均动脉压（mean arterial pressure，MAP）、氧饱和度，验证评估方法的准确率。

结果

3轮专家咨询的积极系数（100.0%、100.0%、88.9%）和协调系数（Kendall’s W从0.144升至0.444，P<0.05）均较高，变异系数范围为0.07~0.27，提示专家意见一致性显著提升；最终确定5个核心二级指标，其权重分别为：灌注血管密度0.1388、MAP 0.131 8、氧饱和度0.129 9、微血管流动指数0.128 1、灌注血管比例0.126 3。量化评分标准显示：5~10分为轻度失血性休克，11~15分为中度失血性休克，16~20分为重度失血性休克；动物实验验证中，该方法区分轻度、中度、重度失血性休克的准确率分别为93.75%（95%CI：71.7%~98.9%）、93.75%（95%CI：71.7%~98.9%）、100%（95%CI：83.8%~100%）。

结论

本研究构建的基于SDF技术与德尔菲法量化休克评估新方法，可精准区分不同严重程度失血性休克（准确率>90%），有效整合宏观循环、氧合与微循环监测维度，解决了传统评估方法轻微观的局限性，为失血性休克的早期精准识别、病情动态监测和针对性复苏提供了可靠的评估工具，具有重要的临床转化潜力。

失血性休克  /  量化评估  /  侧流暗场微循环成像  /  德尔菲法
Objective

Traditional hemorrhagic shock (HS) assessment methods focus solely on macrocirculatory indicators, failing to detect microcirculatory disturbances at an early stage, which may lead to misjudgment of disease severity or delayed intervention. This randomized controlled animal experimental study aims to construct a novel three-level quantitative assessment integrating basic vital signs, blood gas indicators, and microcirculatory parameters, to determine its accuracy and reliability in distinguishing mild, moderate, and severe HS, thereby providing a scientific tool for early precise staging and targeted resuscitation in clinical practice.

Methods

Following the quality control principles of experimental research (randomization, blinded assessment), 20 experts with associate senior professional titles or above in the fields of anesthesiology, critical care medicine, field surgery and other relevant disciplines were selected to conduct 3 rounds of anonymous Delphi consultations. Shock evaluation indicators were screened and their weights were determined by calculating the expert positive coefficient, opinion concentration degree and opinion coordination degree. A three-level assessment system consisting of basic vital signs, blood gas indicators and microcirculatory parameters was constructed, and quantitative scoring standards were formulated. A total of 64 SPF-grade SD rats (12 weeks old) were randomly divided into 4 groups (n=16): a sham operation group and mild, moderate, and severe HS groups (with blood loss accounting for 20%, 35% and 50% of total blood volume, respectively). Side stream dark-field (SDF) microcirculation imaging was employed to detect microcirculatory indicators, and mean arterial pressure (MAP) and oxygen saturation were recorded simultaneously to validate the accuracy of the assessment method.

Results

The positive coefficients (100.0%, 100.0%, 88.9%) and coordination coefficients (Kendall's W increased from 0.144 to 0.444, P<0.05) of the 3 rounds of expert consultations were relatively high, with a coefficient of variation ranging from 0.07 to 0.27, indicating a significant improvement in the consistency of expert opinions. Finally, 5 core secondary indicators were identified, with their weights as follows: perfused vessel density (0.138 8), MAP (0.131 8), oxygen saturation (0.129 9), microvascular flow index (0.128 1) and perfused vessel proportion (0.126 3). The quantitative scoring standard showed that 5 to 10 points indicated mild HS, 11 to 15 points moderate, and 16-20 points severe. In animal experimental validation, the accuracy of this method in distinguishing mild, moderate and severe HS was 93.75% (95%CI: 71.7% to 98.9%), 93.75% (95%CI: 71.7% to 98.9%) and 100% (95%CI: 83.8% to 100%), respectively.

Conclusion

Our novel quantitative HS assessment tool based on SDF technology and Delphi method, can accurately distinguish HS of different severity levels (accuracy rate >90%), effectively integrate the monitoring dimensions of macrocirculation, oxygenation, and microcirculation. Our tool addresses the limitation of traditional assessment tools in neglecting microcirculation, providing reliable assessment for early precise identification, dynamic monitoring of disease progression, and targeted resuscitation of HS, with significant potential for clinical translation.

hemorrhagic shock  /  quantitative assessment  /  side stream dark-field microcirculation imaging  /  Delphi method
朱娱, 吴跃, 李清晖, 李涛. 失血性休克三级量化评估新方法的构建与验证：基于德尔菲法与SDF微循环成像技术的整合研究. 陆军军医大学学报, 2026 , 48 (7) : 895 -904 . DOI: 10.16016/j.2097-0927.202510092
Yu ZHU, Yue WU, Qinghui LI, Tao LI. Development and validation of a novel tertiary quantitative assessment for hemorrhagic shock: an integrated study based on Delphi method and SDF microcirculation imaging technology[J]. Journal of Army Medical University, 2026 , 48 (7) : 895 -904 . DOI: 10.16016/j.2097-0927.202510092
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失血性休克是创伤、外科手术大出血及严重创伤后复苏等场景下的急危重症，其发病急、进展快，且在全球范围内死亡率居高不下，是导致创伤患者、外科手术患者死亡的原因之一。据统计，32.6%~59.5%的创伤伤员死于失血性休克［1］；同时，创伤后失血性休克早期复苏干预每延迟1 min，24 h死亡率增加1.5%［2］，且存活患者易遗留多器官功能障碍、认知损伤等远期并发症。此类休克的核心病理生理特征为组织灌注不足引发的微循环障碍，尽早开展精准评估并及时干预是降低死亡率、改善患者预后的关键［3-5］。在临床实践中，院前急救、急诊创伤救治、重症监护室休克监护及手术室术中大出血管理等关键场景，均迫切需要精准、实时的失血性休克评估方法。目前，血清乳酸、血压、心率等传统的评估方法［6］，虽然有一定的参考价值，但往往难以及时捕捉失血性休克早期组织灌注不足、微循环障碍等病理生理改变，无法全面反映微循环的动态变化，易导致病情误判或救治延误。
随着医学影像技术的发展，侧流暗场（side stream dark-field，SDF）微循环成像技术凭借无创手段，可实时观测舌下、皮肤等部位微循环血流灌注，获取血管密度、血流速度等关键参数，恰好填补了传统指标在微循环监测维度的空白［7-8］。然而，现有研究仅停留在单一指标的实验观察层面，尚未将其与传统临床指标整合，也未形成一套兼具临床实用性与科学严谨性的评估方法，导致其在临床场景中的应用效果未能充分发挥。
德尔菲法作为经典的专家共识方法，通过多轮匿名函询与反馈［9-10］，可有效汇聚并整合急诊科、创伤外科、麻醉科等多学科专家的经验与观点，适用于复杂医学问题的指标筛选与权重确定［11］。该方法通过多轮咨询逐步缩小专家意见分歧，提高共识的科学性与实用性，目前已成功应用于郁病中医证型［12］、孕前和孕期妇女营养评价等领域［13］，为临床实践提供了可靠的决策依据。基于此，本研究在传统的失血性休克评估指标的基础上，结合微循环指标，采用德尔菲法对多学科专家开展3轮咨询，分析专家积极系数、权威系数、意见集中程度（算术平均值、权重值）与意见协调程度（变异系数、Kendall协调系数），依据指标筛选标准（如重要性评分阈值、专家修改建议等）优化指标结构，最终构建一套动态、精准的失血性休克评估新方法。同时，通过失血性休克动物模型模拟病理过程，验证该评估方法的准确性和可靠性。研究成果有望为失血性休克的早期精准识别、病情动态监测及个体化治疗方案制定提供更全面、有效的工具，进而提升失血性休克早期识别率与干预效果，降低死亡率及不良预后风险，最终改善临床结局。
1　对象与方法
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1.1　研究设计
本研究采用方法学构建和随机对照动物实验相结合的双阶段设计。第一阶段为指标体系构建，通过德尔菲法整合多学科专家意见；第二阶段为有效性验证，采用随机对照动物实验设计。质量控制措施包括：①专家遴选严格限定职称（副高级及以上）和工作年限（≥10年），保障专家意见权威性；②动物实验采用随机分组、盲法评估（检测者不知晓动物分组情况）以减少偏倚［14］。
1.2　研究对象
1.2.1　专家咨询对象
选择20名专家参加本次咨询。入选条件：①来自高校、科研机构或三级甲等医院，从事麻醉、重症、野战外科、创伤、急救等相关领域研究或临床工作；②具备副高级或高级职称；③从事相关专业工作10年及以上，具有丰富的理论知识和临床实践经验。
1.2.2　动物实验对象
选择64只12周龄SPF级SD大鼠，雌雄各半，体质量220 g左右，由陆军特色医学中心实验动物中心提供，所有大鼠饲养期间自由饮水、摄食；饲养环境条件为12 h光照、12 h黑暗循环，环境湿度40%~70%，温度22~24 ℃。本研究已获陆军特色医学中心动物管理委员会批准（AMUWEC2020034）。本研究动物实验符合美国国立卫生研究院发布的《实验动物管理与使用指南》。
1.3　方法
1.3.1　指标体系建立
在传统休克评估方法的基础上，结合SDF成像技术的特点，初步构建“基于SDF成像技术的休克评估新方法”的基本指标体系。该体系包括3项一级指标、18项二级指标（表1）。指标筛选的依据：基本生命体征反映失血性休克的宏观循环状态、血气指标反映组织氧合与代谢、微循环指标反映早期微循环状态，三者协同构成完整的休克评估体系。
1.3.2　专家咨询
1.3.2.1　第一轮咨询
发放《基于侧流暗场微循环成像技术的休克评估新方法构建》问卷调查表，请专家对各级指标的重要性进行打分，每级指标总分100分，按指标在本级指标中的相对重要性分配分值，计算百分比权重，专家可对指标提出修改意见。
1.3.2.2　第二轮咨询
针对第一轮咨询后调整完善的指标体系，采用5级重要性判定法（5分=很重要，4分=重要，3分=一般，2分=不重要，1分=很不重要），请专家对各项指标进行量化评分，并说明评分依据。
1.3.2.3　第三轮咨询
结合前两轮咨询反馈意见，请专家对指标进行最终权重打分，明确各级指标的相对重要性。回收问卷后，确定最终指标体系。
1.3.3　相关指标计算
专家积极系数：（回收问卷份数/发出问卷份数）×100％，回收率越高，说明专家参与积极性越高。
专家意见集中程度：以指标重要性算术平均值表示（指标评分值的总和/专家人数平均值），平均值越高说明专家对该指标的认可程度越高。
专家意见协调程度：采用变异系数（coefficient of variation，CV）和Kendall协调系数表示。变异系数=标准差/算术平均值，CV越小说明专家意见波动越小、协调性越好；Kendall协调系数取值范围为0~1，越接近1说明专家意见一致性越高。
指标权重值：单个指标得分/本级指标总得分，反映指标在本级中的相对重要性。
1.3.4　失血性休克模型制备
构建大鼠失血性休克模型，验证评估方法的准确性，确保在临床应用中有可靠的方法学基础。通过固定失血量制备大鼠不同程度的失血性休克模型，即以3%戊巴比妥钠腹腔麻醉大鼠，进行动脉插管，待插管完成且动物生命体征稳定10 min后，开始通过股动脉导管进行放血。通过控制放血量来制备不同程度的休克模型：当放血量达到大鼠总血容量（按体质量的7%估算）的20%时，定义为轻度休克；放血量达总血容量的35%时，定义为中度休克；放血量达总血容量的50%时，定义为重度休克［15-16］。此方法有效模拟了临床上的渐进性失血过程，为后续评估微循环动态变化提供了稳定、可分级的研究基础。
1.3.5　指标测定
大鼠达到目标失血量后，采用SDF技术检测灌注血管密度、灌注血管比例和微血管流动指数。具体方法为：将大鼠的舌体固定，在SDF显微镜下获取舌面两侧不同区域的图像，并计算各参数，包括灌注血管密度、灌注血管比例和微血管流动指数。同时记录大鼠的平均动脉压（mean arterial pressure，MAP）和氧饱和度。
1.3.6　评分标准的应用
根据构建的《基于SDF评估休克的新方法》对失血性休克动物进行评分。当评分在16~20分，为重度失血性休克；评分在11~15分，中度失血性休克；评分在5~10分，为轻度失血性休克；当评分<5分，为正常。若动物失血性休克的程度与评分结果一致，说明该方法评估准确率高。
1.4　统计学分析
运用Excel软件计算各指标平均得分、变异系数以及专家积极系数；运用SPSS 31软件计算Kendall协调系数，并进行χ2检验，P<0.05表示专家意见协调性好，结果可取。
2　结果
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2.1　高资历多学科专家构成提升咨询意见权威性
遵循德尔菲法“专家代表性、广泛性”原则，结合研究需求，经自愿筛选共遴选20名多学科专家完成3轮咨询。专家均来自麻醉、重症医学、野战外科、创伤急救等休克诊疗核心领域，年龄、职称、工作年限及专业领域分布合理。其中正高级职称占80%（16/20），平均从业年限25.25±6.65年，具备扎实的理论与临床经验，为指标体系构建提供了可靠的专业支撑与权威保障（表2）。
2.2　3轮专家咨询积极系数持续处于高水平
3轮专家咨询的积极系数分别为100.0%（20/20）、100%（18/18）、88.9%（16/18），均保持较高水平。其中前2轮问卷回收率达100%，第3轮虽略有下降，但仍远高于德尔菲法70%的最低有效回收率标准，反映专家对本研究主题的高度认可及参与积极性，有效减少了因低回收率导致的结果偏倚。
2.3　专家意见的集中和协调程度持续提升
以指标重要性算术平均值反映专家意见集中程度，数值越高表明专家对指标重要性的认可一致性越强。第1轮咨询中，一级指标重要性百分比范围为20.50%~41.00%，二级指标为8.00%~36.00%；第2轮咨询后，一级指标平均得分为4.44~4.67分，二级指标平均得分为3.78~4.89分；第3轮咨询中，一级指标平均得分为4.56~4.88分，二级指标平均得分为3.81~4.88分，整体呈逐步上升趋势，说明随着咨询轮次增加，专家对指标重要性的认知愈发集中。2轮咨询二级指标重要性的Kendall协调系数差异有统计学意义（表3，P<0.05）。
2.4　冗余指标经多轮筛选后聚焦核心评估维度
2.4.1　第1轮专家咨询结果统计
第1轮问卷共发出调查表20份，回收20份。从专家打分统计结果可见，专家对休克评估新方法的“微循环指标”的认可率最高，对“血气指标”认可率相对较低。调查中有几位专家认为“基本生命指标”比“微循环指标”更重要，但更多的专家认为“微循环指标”比“基本生命指标”更重要，因为微循环指标更直接、更早期反映休克时组织细胞的灌注和代谢状态。
二级指标“基本生命指标”中的“休克指数”和“平均动脉压”的专家认可度较高；“心率”“呼吸”和“尿量”专家认可率相对较低；有专家指出，心率的改变受情绪、发热以及心脏本身疾病等多种因素影响，用于评估休克不够准确；“呼吸”同样也受多种因素影响，单纯依据呼吸频率来判断休克的发生和进展较难。二级指标中“碱缺失”和“二氧化碳分压”的专家认可度相对较低。有专家指出，二级指标“碱缺失”和pH值都反映体内酸碱平衡情况，碱缺失主要用于评估代谢性酸中毒的程度，受多种因素影响，特异性不强；“二氧化碳分压”主要反映肺泡通气情况，受呼吸影响大，对休克的直接评估相对有限。二级指标“血管总密度”与“异质性指数”专家的认可度较低，“灌注血管密度”“灌注血管比例”和“微血管流动指数”这3个指标专家认可度较高。“血管总密度”是单位面积内血管的总数，包括灌注血管和非灌注血管，不管是否发生休克，血管的总密度一般不会发生明显的变化，对休克的即时评估意义不大；“异质性指数”主要描述微血管灌注的一致性，相比之下，“灌注血管密度”“灌注血管比例”和“微血管流动指数”能更直接、简单反映休克时微循环的主要问题（表4）。
2.4.2　第2轮专家咨询统计结果
在第2轮专家咨询中，专家对一级指标重要性判断可见，“微循环指标”和“基本生命指标”重要程度均大于60%以上，认可率较高，“血气指标”的认可率相对降低；从专家对二级指标重要性判断结果可见，除“尿量”“神志”“氧分压”和“pH”指标外，其余指标的重要程度均高于60%，其中，“休克指数”“MAP”“氧饱和度”和“灌注血管比例”的重要程度均高于80%（表5）。
2.4.3　第3轮专家咨询统计结果
第3轮专家咨询共发出调查表18份，回收调查表16份，回收率为88.9%。根据专家打分结果可见，毛细血管再充盈、血乳酸的得分和权重值相对较低；MAP、氧饱和度、灌注血管密度、灌注血管比例和微血管流动指数的得分和权重值相对较大，说明专家认为这些指标均很重要（表6）。
2.5　量化评分指标成功建立并明确休克分级标准
通过3轮专家咨询，形成了基于SDF成像技术的评估失血性休克的新方法，该评估方法共纳入5个二级指标，通过对评估指标的严重程度进行赋值，建立了不同失血性休克程度判定的评分标准（表7）。
2.6　新评估方法对不同程度休克的区分准确率超 90%
通过制备轻度、中度和重度失血性休克的动物模型，测量动物的平均动脉压、氧饱和度、灌注血管密度、灌注血管比例和微血管流动指数，根据上述基于SDF评估失血性休克的新方法对休克严重程度的评分标准，对失血性休克不同程度的大鼠进行评分，结果发现，在轻度失血性休克中，16只大鼠中仅有1只的休克评分大于10分，其余15只动物均在5~10分，评估的准确率为93.75%（95%CI：71.7%~98.9%）；在中度失血性休克中，同样也是一只动物超过了15分，其余均在10~15分之间，准确率为93.75%（95%CI：71.7%~98.9%）；在重度失血性休克中，所有的动物评分都在15~20分之间，准确率100%（95%CI：83.8%~100%）（图1）。综上，用上述方法评估不同程度的失血性休克准确率>90%，说明新评估方法能准确区分不同程度休克。
3　讨论
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3.1　多轮德尔菲法高效凝聚多学科共识，保障指标体系科学性
本研究基于SDF微循环成像技术结合德尔菲法，构建了涵盖基本生命指标、血气指标及微循环指标的三级量化评估方法，经64只SD大鼠失血性休克模型验证，该方法对不同严重程度休克区的分准确率均超90%。该方法通过整合宏观循环、氧合与微循环监测维度，解决了传统评估方法的核心短板，具有明确的创新价值与临床转化潜力。
德尔菲法作为复杂医学问题指标筛选的经典工具，其核心优势在于通过多轮匿名函询汇聚多学科专家智慧［17］，尤其适用于休克评估这类涉及循环、代谢、微循环等多系统交互的复杂议题［18］。德尔菲法在相关评估体系构建中具有显著价值。HOLDER等［19］采用三轮德尔菲法，联合10名重症医学医师与3名护士，从24项候选指标中筛选出19项与血流动力学恶化高度相关的指标，最终确定减少血流动力学不稳定时间和缩短识别延迟时间为优先干预目标。该研究验证了德尔菲法在整合临床实践经验与科研证据中的有效性。雷娟等［20］通过德尔菲法对13名专家开展两轮函询，确定最终风险评价体系，构建了感染性休克患者中心静脉导管相关血流感染风险评价指标体系，为临床医护人员早期识别感染高危风险，采取相应措施提供参考。
本研究遴选20名专家均来自麻醉、重症、野战外科、创伤急救等休克诊疗核心领域，其中正高级职称占80%（16/20），平均从业年限达（25.25±6.65）年，覆盖休克基础研究与临床实践全维度，符合德尔菲法专家需具备丰富理论与实践经验的要求［21］。虽未直接计算权威系数，但高职称、长工龄的专家构成可充分保障意见的专业可信度，避免单一领域的偏见。3轮咨询积极系数分别为100%、100%、88.9%，第3轮咨询虽回收率略有下降（88.9%），但仍保持高参与度，反映专家对本研究主题的认可与关注，减少了因低回收率导致的结果偏倚。第三轮咨询中，所有一级指标变异系数均<0.2（微循环指标变异系数最低，仅0.070 1），二级指标的Kendall协调系数逐渐增加（0.144增加到0.444），并且P值<0.05，提示专家对指标重要性的判断一致性高，赋值波动小。这一结果与德尔菲法通过多轮反馈缩小意见分歧的核心目标一致，说明最终确定的指标体系并非单一专家主观判断，而是多学科共识的体现。
3.2　核心指标筛选贴合失血性休克的病理生理，实现宏、微观评估全覆盖
本研究通过3轮咨询逐步删减冗余指标、聚焦核心指标，筛选逻辑严格贴合休克循环功能障碍、微循环障碍、组织灌注不足的病理生理进展，同时兼顾临床实用性与指标特异性。
基本生命指标中，心率、呼吸因受非休克因素干扰显著（心率受情绪、发热、心脏基础疾病影响，呼吸受肺部疾病、通气模式干扰），专家认可度低（第1轮重要程度仅9%、8%），删除后可避免“假阳性评估”；尿量、神志虽与循环相关，但第2轮咨询中“很重要”比例均不足60.0%（尿量55.6%、神志44.4%），且尿量受补液速度、肾功能影响，神志受镇静药物干扰，临床解读易误判，故予以剔除。血气指标中，碱缺失与pH值均反映酸碱平衡，前者特异性低（受呕吐、利尿剂等因素影响），二氧化碳分压主要评估肺泡通气，对休克组织灌注障碍的直接指向性弱（第1轮重要程度为10.5%），删除后可精简血气评估维度，聚焦氧饱和度、血乳酸等核心氧合与代谢指标。微循环指标中，血管总密度因包含灌注血管+非灌注血管，休克状态下血管总量无显著变化，无法反映即时灌注状态（第1轮重要程度为12.75%）；异质性指数虽描述灌注一致性，但专家认为其解读复杂度高于灌注血管密度、灌注血管比例、微血管流动指数，且后三者可更直接量化有效灌注血管的数量与功能，故删除后更符合临床简单、直观的评估需求。
最终保留的5项二级指标（MAP、氧饱和度、灌注血管密度、灌注血管比例、微血管流动指数）形成宏观循环、氧合、微观灌注的完整评估链。其中MAP是宏观循环灌注的基础，直接反映器官灌注压力，为休克复苏的核心监测目标［22］；氧饱和度量化血液携氧能力，避免灌注正常但氧合不足的漏判；3项微循环指标直接填补传统指标的空白——休克早期常存在血压正常但微循环障碍的隐性休克［23］，SDF技术可实时观测舌下微循环的灌注血管数量与流动状态，其指标变化早于血压、乳酸等传统指标［24］，可实现早期识别、早期干预。
3.3　量化评分标准区分不同休克程度效能优异
基于指标权重与休克程度关联，本研究制定了轻、中、重度休克评分标准（5~10分轻度休克、11~15分中度休克、16~20分重度休克），避免了传统评估的主观性。动物实验验证显示，该方法对大鼠失血性休克的评估准确率均>90%，且能有效区分不同休克程度（重度休克准确率100%）。目前临床上对休克的严重程度缺乏高度客观、统一的量化标准。本研究提出的评分方法，将复杂的微循环影像转化为简洁的分数区间，并在动物模型中取得了>90%的区分准确率。这种标准化和可量化的特性，极大地减少了主观偏差。若未来能转化至临床，该评分可以作为一种强大的决策支持工具，帮助急诊、ICU医生快速、客观地判断患者休克阶段，为制定个体化的复苏方案（如液体种类、速度、血管活性药物的使用时机等）提供关键依据，从而有望改善患者预后。
3.4　新评估方法填补传统方案短板，临床转化潜力显著
本研究构建的评估方法与《创伤失血性休克中国急诊专家共识（2023版）》的核心目标高度一致，均以早期识别、改善预后为核心［15］。专家共识推荐的血压、心率等指标虽能快速判断显性休克，但无法反映早期微循环灌注异常，而本研究纳入的3项微循环指标（灌注血管密度、灌注血管比例、微血管流动指数）可早于乳酸、血压变化，识别隐性休克，避免因代偿期宏观指标正常导致的干预延误［25］。
该方法在复杂临床环境中具有重要应用前景，在急诊与重症监护场景中，可辅助医生快速判断休克阶段，制定个体化复苏策略；在战创伤、灾害医学等资源受限场景中，为分级救治与资源调配提供依据；在复苏过程中，微循环指标可作为复苏终点，避免过度输液或血管活性药物滥用。本研究采用的SDF技术具有无创、床旁可及的特性，无需复杂设备，可直接适配专家共识涉及的所有场景（尤其适合院前急救、战创伤等资源受限环境）；同时，研究保留了专家共识推荐的核心指标（如平均动脉压、氧饱和度），仅补充微循环维度，无需改变临床现有操作习惯，降低了专家共识与本评估体系结合应用的门槛。
3.5　研究局限性
本研究虽构建了可靠的休克评估新方法，但仍存在局限：①专家咨询的覆盖范围为20人，虽符合德尔菲法“15~50人”的推荐范围，但专家专业领域以重症医学、麻醉、创伤急救、野战外科等临床学科为主，未来可进一步拓展至中医急救、急诊护理、卫生统计学、临床流行病学等相关领域，以提升研究结论的代表性与普适性；②缺乏临床验证，尚未在人类休克患者中开展研究，由于伦理限制无法在人类健康志愿者或患者中构建不同程度失血性休克模型，动物模型是唯一能可控验证指标体系准确性的载体。下一步需纳入创伤、重症等领域患者，验证评估失血性休克新方法的临床有效性。
综上所述，本研究通过德尔菲法构建了包含基本生命体征、血气指标、微循环指标的三级评估体系，并以大鼠失血性休克模型为载体，验证体系准确率>90%。动物实验的意义在于为临床转化提供方法学依据。研究成果为失血性休克的早期精准评估、病情分期及个体化复苏提供了新工具，下一步需进一步扩大专家共识范围（如纳入中医急救、循证医学领域专家），通过临床研究进一步优化，最终服务于临床诊疗实践。

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doi: 10.16016/j.2097-0927.202510092
  • 接收时间：2025-11-25
  • 首发时间：2026-10-23
  • 出版时间：2026-04-15
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  • 收稿日期：2025-11-25
  • 修回日期：2026-02-11
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    1陆军军医大学大坪医院战伤休克与输血研究室，创伤与化学中毒全国重点实验室，重庆

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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