中心静脉压和氧代谢指标联合诊断感染性休克相关左心功能不全的价值  

The application of combined central venous pressure and oxygen metabolism parameters monitoring in diagnosing septic shock-induced left ventricular dysfunction

作　　者：崔克亮[1] 王小亭[1] 张宏民[1] 柴文昭[1] 刘大为[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院重症医学科,100730

出　　处：《中华内科杂志》2015年第10期855-859,共5页Chinese Journal of Internal Medicine

基　　金：首都卫生发展科研专项项目（首发2011-4001-05）

摘　　要：目的 探讨中心静脉压（CVP）、中心静脉血氧饱和度（ScvO2）、静-动脉血二氧化碳分压差（Pv-aCO2）联合诊断感染性休克相关左心功能不全的价值.方法 选2013年9月至2014年9月北京协和医院重症医学科诊治的感染性休克患者93例,记录CVP、ScvO2、Pv-aCO2.以超声心动图检测左室射血分数＜50％为标准,将患者分为新发左心功能不全组和未发左心功能不全组.使用logistic回归建立诊断模型,通过ROC曲线评价各指标单独及联合诊断的价值.结果 93例感染性休克患者中,39例发生左心功能不全.新发左心功能不全组CVP[（12.5±3.9）mmHg（1 mmHg=0.133 kPa）比（10.4±2.5）mmHg,P=0.005]、Pv-aCO2[（7.5±3.9） mmHg比（4.5±2.6） mmHg,P ＜0.001]显著高于未发左心功能不全组,ScvO2显著低于未发左心功能不全组[（62.4±10.5）％比（72.6±9.0）％,P＜0.001],差异有统计学意义.采用CVP、Pv-aCO2、ScvO2诊断新发左心功能不全时,CVP≥12.5 mmHg敏感度为46.2％,特异度为81.5％,AUCROC为0.674;Pv-aCO2 ≥5.0 mmHg敏感度为76.9％,特异度为37.0％,AUCRoC为0.738;ScvO2≤65.8％敏感度为64.1％,特异度为78.6％,AUCROC为0.775.以logistic回归预测概率作为诊断指标、根据ROC曲线确定界值,诊断模型≥0.377,敏感度为82.1％,特异度为79.6％,AUCROC为0.835.结论 对感染性休克患者是否发生左心功能不仝,通过Pv-aCO2、ScvO2、CVP建立logistic回归模型,利用预测概率进行辅助诊断具有一定价值。Objective To evaluate the value of central venous pressure （CVP）,central venous oxygen saturation （ScvO2） and venous-arterial carbon dioxide partial pressure gradient （Pv-aCO2） in the diagnosis of septic shock-induced left ventricular dysfunction.Methods Consecutive patients with septic shock were enrolled from September 2013 to September 2014 in ICU at Peking Union Medical College Hospital.The data of CVP,Pv-aCO2 and ScvO2 were recorded and analyzed.According to the left ventricular ejection fraction （LVEF） tested by bedside echocardiography,the patients were divided into two groups：new onset of left ventricular dysfunction （LVEF 〈 50%） group and non-left ventricular dysfunction （LVEF ≥ 50%） group.A diagnostic model was created by logistic regression.The diagnostic performance and cut-off values of CVP,Pv-aCO2,ScvO2 were determined using receiver operating characteristic （ROC） curve analysis.Results Among 93 patients enrolled,39 were diagnosed with left ventricular dysfunction.In the new onset group,CVP [（12.5±3.9） mmHg（1 mmHg=0.133 kPa） vs （10.4±2.5）mmHg;P=0.005] and Pv-aCO2 [（7.5 ± 3.9） mmHg vs （4.5 ± 2.6） mmHg;P 〈 0.001] were significantly higher than those in the non-left ventricular dysfunction group,while ScvO2 [（62.4 ± 10.5） % vs （72.6 ± 9.0） %;P 〈 0.001] was significantly lower.As far as the diagnostic value of these three parameters were concerned for left ventricular dysfunction,the sensitivity of CVP ≥ 12.5 mmHg was 46.2%,specificity 81.5% with an area under ROC curve （AUCROC） 0.674;the sensitivity of Pv-aCO2 ≥ 5.0 mmHg 76.9%,specificity 37.0%,AUCROC 0.738;the sensitivity of ScvO2 ≤65.8% 64.1%,specificity 78.6%,AUCROC 0.775.When the cut-off values were determined by ROC,the diagnostic performance of the model was ≥0.377 with the sensitivity,specificity and AUCROC 82.1%,79.6% and 0.835,respectively.Conclusion In patients with septic shock,the logistic regression model established by CVP,Pv-aCO2 and ScvO2 contributes to

关 键 词：休克 脓毒性 左心功能不全 中心静脉压 LOGISTIC模型 

分 类 号：R459.7[医药卫生—急诊医学]