摘要
目的探讨脓毒症休克患者心功能的动态变化及对预后的影响。方法选取北京朝阳医院急诊ICU2014年至2016年1月收治的129例脓毒症休克患者，以持续脉搏轮廓波形法监测血流动力学参数，包括平均动脉压（MAP）、心指数（CI）及全身血管阻力指数（SVRI）。于入院即刻及第7天行心脏超声检查，测量左心室射血分数（LVEF）、二尖瓣舒张早期充盈峰速度E峰和舒张晚期充盈峰速度A峰比值（E／A）、二尖瓣环舒张早期速度（E＇）及E／E’比值。根据28d预后将患者分为生存组与死亡组，确定预后不良的危险因素。结果所有患者入院第1天表现为“高排低阻”型休克，生存组与死亡组患者的CI[（4．30±0．71）L／（min·m2）与（4．52±0．91）]L／（min·m^2）和SVRI[（1477±297）dyn·S·cm^-5·m^2与（1488±233）]dyn·s·cm^-5·m^2差异无统计学意义（均P〉0．05）。入院后第7天生存组与死亡组患者SVRI[（2044±266）dyn·s·cm^-5·m^2与（3201±329）dyn·s·cm^-5·m^2]均显著高于第1天；CI[（3．88±0．51）L／（rnin-m2）与2．52±0．87）L／（min·m2）]均显著低于第1天（均P〈0．05）。但死亡组患者CI显著低于生存组，SVRI显著高于生存组（均P〈0．05）。生存组与死亡组入院第1天LVEF[（69．1±12．5耽与（69．5±11．2溉]及E／E’（8．43±0．59）与（8．89±0．64）差异无统计学意义（均P〉0．05）；7d后，生存组与死亡组相比差异有统计学意义（均P〈0．05），与生存组相比，死亡组LVEF显著降低[（64．4±16．3）％与（54．4±17．6）％]，E／E’显著升高（8．73±0．67）与（9．97±0．55）oLogistic回归显示，APACHEI／评分（OR=1．667，95％CI：1．322-1．863，P=0，001）、LVEF（OR=0．809，95％CI：0．612-0．912，P=0．001）和E／E’（OR=1.219，95％CI：1．030～1．501，P=0．006）是预测28d死亡的独立危险因素。结论脓毒症休克患者�
Objective To investigate the dynamic change of cardiac function in the patients of septic shock and analyze its influence to prognosis. Methods A total of 129 patients in department of emergency medicine, Beijing Chao-Yang Hospital, Capital Medical University, from January 2014 to January 2016 were enrolled in the investigation using mornitoring the hemodynamics including the contour pulse wave mean artery pressure （MAP）, cardiac index （CI） and systemic vascular resistance indes （SVRI）. Echocardiography was done 7 days laterenrollment of left ventricular eject fraction （LVEF）, E and A peak of mitral blood flow velocity, mitral annulus moving speed （E＇） were detected changes. E/A and E/E＇ were calculated. According to the 28-day prognosis, all patients were devided into the survival and death group for detecting the risk factors of death. Results In all patients, hemodynamics detected changes showed the features of septic shock with high output and low vascular risistance. The values of CI in the survival group and death group were （4.30±0.71） L/（min. m2） and （4.52±0.91） L/（min · m2）, repectively, and the values of SVRI were （1 477±297） dyn·s·cm^-5·m^2 and （1 488＋233） dyn·s·cm^-5·m^2, repectively. There were no significant differences in CI and SVRI were found between the two groups （boths：P〉0.05）. When 7 days after admission in hospital, CI [（3.88±0.51） L/（min. m2）] was lower and SVRI [（2 044±266） dyn·s·cm^-5·m^2] was higher compared with those at admission in the survival group with significant differences, between the two intervals （all P〈0.05）. In the death group, CI decreased to （2.52±0.87） L/（min · m2） and SVRI increased to （3 201±329） dyn·s·cm^-5·m^2 after admission on the 7th day in hospital, significant differences between the two groups （all P〈0.01）. There were significantly differenced with LVEF [（69.1±12.5）% vs. （69.5±11.2）%] and E/E＇ （8.43±0.59） vs. （8.89±0.64） found
作者
王烁
吴彩军
杨军
唐子人
Wang Shuo;Wu Caijun;Yang Jun;Tang Ziren(Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第4期389-393,共5页
Chinese Journal of Emergency Medicine
基金
北京市自然科学基金（7162071）
