摘要
目的探讨液体平衡状态和心功能变化与脓毒性休克患者预后的关系。方法对2013年1月至2015年1月天津医科大学第二医院符合脓毒性休克诊断标准的92例围手术期患者进行回顾性分析，根据28d病死率分为生存组和死亡组，比较两组之间液体平衡状态、血流动力学指标、血清B型钠尿肽的水平。结果本组92例脓毒性休克患者中生存44例，死亡48例，病死率为52％。生存组前7d液体总平衡量少于死亡组[（55±9）ml／kg比（187±14）ml／kg，t=54．260，P〈0．01]；生存组第1天左心室射血分数低于死亡组[（42％±4％）比（54％±6％），江10．100，P〈0．01]；生存组血清B型钠尿肽水平低于死亡组[（267±54）ng／L比（681±22）ng／L，t=48．580，P〈0．01]。液体正平衡、左心室射血分数、急性生理学与慢性健康状态评分Ⅱ是影响患者死亡的独立危险因素（P〈0．05）。结论液体平衡状态和心功能指标可以作为脓毒性休克患者预后的预测因素。
Objective To evaluate the correlation between fluid balance and myocardial function and the mortality in patients with septic shock. Methods Ninety two septic shock patients enrolled between January 2013 and January 2015 were divided into survival group and non-survival group based on 28-day mortality. Fluid balance, haemodynamic parameters and B-type natriuretic peptide （BNP） were collected on days1,3,7 after admission. Results Forty four patients survived the crisis while 48 died. The 7 day average fluid balance volume in survival group was lower than those in non-survival group [ （55±9 ） ml/kg vs. （ 187±14 ） ml/kg, t = 54. 260, P 〈 0. 01 ]. The initial left ventricle ejection fraction （LVEF） in survival group was lower than that in non-survival group E （42% ±4% ） vs. （54% ±6% ） ,t = 10. 100, P 〈 0.01]. Serum BNP level was significantly lower than those in non-survival group[（ 267±54 ） ng/L vs. （681±22） ng/L, t = 48. 580, P 〈 0. 01 ]. Multivariate logistic regression analysis showed that fluid positive balance, LVEF and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） were the independent predictors for 28 day mortality （ P 〈 0. 05 ）. Conclusions Fluid balance and myocardial function can serve as risk predictors for septic shock patients.
出处
《中华普通外科杂志》
CSCD
北大核心
2016年第5期402-405,共4页
Chinese Journal of General Surgery
基金
天津市卫计委科技基金资助项目（2014KZ103）
关键词
休克
脓毒性
心力衰竭
预后
Shock, septic
Heart failure
Prognosis
