早期液体复苏对脓毒性休克患者左心室舒张功能的影响  

Effects of early fluid resuscitation on left ventricular diastolic function in patients with septic shock

作　　者：夏嘉鼎[1] 苏震 段立娟[1] 张坤[1] 滑立伟[1] 

机构地区：[1]承德医学院附属医院重症医学科,河北承德067000

出　　处：《河北医科大学学报》2017年第9期1015-1019,共5页Journal of Hebei Medical University

基　　金：河北省科技支撑计划项目(152777205)

摘　　要：目的观察并探讨早期液体复苏对脓毒性休克患者左心室舒张功能的影响。方法选择左心室舒张功能障碍的脓毒性休克患者45例,对患者进行早期液体复苏,6h后将达到复苏目标[中心静脉压8~12mmHg(机械通气下12~15mmHg)、平均动脉压≥65mmHg、尿量≥0.5mL·kg^(-1)·h^(-1)、中心静脉氧饱和度≥70%]者纳入观察组(31例),未达标患者纳入对照组(14例)。应用床边超声测量患者二尖瓣舒张早期峰流速与二尖瓣环舒张早期运动速度比值(E/e′)作为评估左心室舒张超声指标,同时观察心肌损伤标记物肌钙蛋白I(cardiac troponin I,cTnI)及N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平变化。结果观察组机械通气时间、住重症医学科时间均较对照组明显缩短(P<0.05);观察组多器官功能障碍综合征发生率及28d病死率显著降低(P<0.05)。与液体复苏前比较,观察组在复苏后6hE/e′、NT-proBNP明显下降(P<0.05);观察组复苏后E/e′、cTnI及NT-proBNP均较对照组低,差异有统计学意义(P<0.05)。结论脓毒性休克患者经早期液体复苏可显著改善左心室舒张功能,减轻心肌损伤,改善预后。Objective To observe and to explore effects of early fluid resuscitation on left ventricular diastolic function in patients with septic shock.Methods Forty-five septic shock patients with left ventricular diastolic dysfunction were chosen.Patients who achieved the resuscitation goals（central venous pressure 8-12 mmHg,or 12-15 mmHg during mechanical ventilation,mean arterial pressure≥65 mmHg,urine volume≥0.5 mL·kg^（-1）·h^（-1）,central venous oxygen saturation≥70% after 6 hours treatment of early fluid resuscitation）were assigned into observation group（31cases）.Patients who did not achieve the resuscitation goals were assigned into control group（14 cases）.As the evaluation index of left ventricular diastolic function,the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity（E/e′）was observed by bedside ultrasound.Meanwhile,the myocardial injury markers including cardiac troponin I（cTnI）and N-terminal pro-brain natriuretic peptide（NT-proBNP）were observed.Results The duration of mechanical ventilation and length of stay in intensive care unit were significantly shorter in observation group compared with control group,meanwhile the incidence of multiple organ dysfunction syndrome and 28 day-mortality were decreased significantly（P〈0.05）.E/e′and NT-proBNP in observation group were decreased remarkably after fluid resuscitation（P〈0.05）.E/e′,cTnI and NT-proBNP were significantly lower in observation group compared with control group（P〈0.05）.Conclusion Left ventricular diastolic dysfunction could be improved evidently through early fluid resuscitation.Effect of myocardial injury was relieved and prognosis was improved in patients with septic shock.

关 键 词：休克 脓毒性 液体复苏 左心室舒张功能 心肌损伤 

分 类 号：R631.4[医药卫生—外科学]