难治性感染性休克左心室-动脉偶联变化的临床观察  

Clinical observation of left ventricular-arterial coupling in refractory septic shock

作　　者：杨璇[1] 李长江 冯磊[1] 延荣强[1] 李玉 

机构地区：[1]青岛市市立医院心内科 [2]青岛市中心医院心内科,山东青岛266000 [3]淄博市政府机关医院心内科,山东淄博255000

出　　处：《临床和实验医学杂志》2014年第22期1844-1846,共3页Journal of Clinical and Experimental Medicine

基　　金：青岛市卫生局课题支持项目(2012-WSZD024)

摘　　要：目的探讨难治性感染性休克患者左心室-动脉偶联的变化及其临床意义。方法选择53例难治性感染性休克患者,监测起始点及24 h点心指数(CI)、每搏指数(SVI)、左心室收缩末弹性指数(Eesl)、有效动脉弹性指数(Eal)、有效动脉弹性/左心室收缩末弹性(Ea/Ees)、动脉血乳酸(Lac)和乳酸清除率(r Lac)等指标,将患者分为ΔEa/Ees>0组(n=19),ΔEa/Ees≤0组(n=34),随访28 d的患者生存情况。结果随访28 d死亡率发现,ΔEa/Ees>0组病死率为68.4%(13/19),显著高于ΔEa/Ees≤0组38.2%(13/34)(χ2=4.444,P=0.035)。ΔEa/Ees>0组r Lac为(-2.6±0.3)%,ΔEa/Ees≤0组的r Lac为(5.9±1.3)%,两者存在显著差异(t=9.762,P<0.001)。ΔEa/Ees≤0组24 h CI、SVI显著高于ΔEa/Ees>0组,Ea I、Ea/Ees显著低于ΔEa/Ees>0组,其余项无统计学差异。逐步Logistic回归发现,24 h点ΔEa/Ees、24 h点的APACHE II评分是影响患者28 d死亡的危险因素。结论关注难治性感染性休克中左心室-动脉偶联意义重大,可改善患者组织灌注,从而对改善预后具有重要意义。Objective To investigate the left ventricular- arterial coupling in refractory septic shock. Methods Fifty- three cases of refractory septic shock were collected. Cardiac index（ CI）,stroke volume index（ SVI）,left ventricular end- systolic elastance index（ Eesl）,effective arterial elastance index（ Eal）,effective arterial elastance / left ventricular end- systolic elastance（ Ea / Ees）,arterial blood lactate（ Lac）and lactate clearance rate（ r Lac） and other indicators were obtained at the beginning and the 24 th hour of monitoring. Patients were divided intoΔEa /Ees〉 0 group（ n = 19） and ΔEa / Ees≤0 group（ n = 34）. The mortality rate at day 28 was obtained by follow- up. Results The mortality rate at day 28 in ΔEa / Ees〉0 group was 68. 4%（ 13 /19）,significantly higher than 38. 2%（ 13 /34） in ΔEa / Ees≤0 group（ χ^2= 4.444,P = 0. 035）. r Lac in ΔEa / Ees〉0 group was- 2. 6 ± 0. 3%,but it was 5. 9 ± 1. 3% in ΔEa / Ees≤0 group; there was a significant difference between the two（ t = 9. 762,P〈0. 001）. CI and SVI at the 24 th hour in ΔEa / Ees ≤0 group were significantly higher than ΔEa / Ees〉0 group and Ea I,Ea / Ees were significantly lower than ΔEa / Ees〉0 group. No significant difference was found in the remaining parameters. Stepwise logistic regression found that ΔEa / Ees and APACHE II score at the 24 th hour were risk factors for the mortality at day 28 in patients. Conclusion The study of left ventricle- arterial coupling in refractory septic shock has great significance for improving tissue perfusion and prognosis.

关 键 词：感染性休克 左心室-动脉偶联 血流动力学 组织灌注|| 

分 类 号：R459.7[医药卫生—急诊医学]