老年脓毒血症性休克患者脉搏指示连续心排血量技术检测血流动力学特点  

Hemodynamics of elderly patients with septic shock monitored by pulse indicator continuous cardiac output

作　　者：孙照琨[1] 陈蕊[1] 熊日成[1] 肖飞[1] 莫泽珣[1] 郭振辉[1] Sun Zhaokun;Chen Rui;Xiong Richeng;Xiao Fei;Mo Zexun;Guo Zhenhui(Department of Medical Intensive Care Unit, the General Hospital of Guangzhou Military Command, Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support ,Guangzhou 510010 ,China)

机构地区：[1]广州军区广州总医院老年重症医学科广东省暨广州市老年感染与器官功能支持重点实验室,510010

出　　处：《中华老年医学杂志》2018年第4期409-412,共4页Chinese Journal of Geriatrics

基　　金：广东省科技计划项目（2012A061400010）;广州市科技计划项目健康医疗协调创新重大专项（201508020253）;广州市科技计划项目科学专项（2014J4100033）

摘　　要：目的了解脉搏指示连续心排血量技术（PiCCO）检测下老年脓毒性休克患者血流动力学特点。方法回顾性分析我科2015年1月至12月进行PiCCO检测的50例老年脓毒性休克患者的性别、年龄、入科急性生理和慢性健康状况评价系统（APACHE）Ⅱ评分、序贯性脏器衰竭评价评分（SOFA）、PiCCO结果[包括心指数（CI）、每搏量指数（SVI）、全身血管指数（SVRI）、心功能指数（CFI）、全心射血分数（GEF）、左心收缩力指数（dPmx）、全心舒张末容积指数（GEDVI）、胸腔内血容积指数（ITBVI）、血管外肺水指数（EVLWI）、肺血管通透性指数（PVPI）]及临床结局等临床资料。结果多数患者CI、SVI、CFI和全心射血分数GEF偏低，分别为70.0%（35例）、82.0%（41例）、78.0%（39例）、92.0%（46例），EVLWI偏高，为68.0%（34例）。与〈75岁组比较，≥75岁组CI降低患者比例高，分别为22.2% （2例）、80.5%（33例）（χ2＝13.511，P＝0.001）；CFI降低患者比例高，分别为44.4% （4例）、85.4%（35例）（χ2＝7.236，P＝0.027）；SVRI升高患者比例高，分别为0.0% （0例）、58.5%（24例）（χ2＝10.392，P＝0.006）。采用Pearson相关分析CI、CFI与年龄的相关性，结果显示，CI、CFI与年龄均呈负相关（r＝－0.460、－0.384，P＝0.001、0.006）。有糖尿病病史患者CFI低于无糖尿病病史患者[（2.70±0.67）L/min比（3.64±1.54）L/min，t＝2.189、P＝0.033]；有慢性阻塞性肺疾病病史患者EVLWI高于无慢性阻塞性肺疾病病史者[（13.83±7.60）L/min比（9.61±4.24）L/min，t＝－2.062、P＝0.045]。PVPI升高者3 d死亡率较PVPI正常者高[80.0%（4例/5例）比28.9%（13例/45例），χ2＝5.239、P＝0.022]，28 d内死亡的31例患者平均EVLWI为（11.10±5.57） ml/kg，高于19例生存者EVLWI（8.53±2.85）ml/kg（t＝－2.150、P＝0.037）。结论老年患者脓毒性休克时心功能更差，更易出现肺水�ObjectiveTo investigate the changes of cardiovascular hemodynamics in elderly patients with septic shock using pulse indicator continuous cardiac output （PiCCO）.MethodsFifty elderly patients with septic shock at the General Hospital of Guangzhou Military Command were enrolled from January 2015 to December 2015.We collected clinical data, including gender, age, acute physiological and chronic health evaluation （APACHE Ⅱ） score, sequential organ failure assessment （SOFA） score, and the PiCCO parameters, such as cardiac index （CI）, stroke volume index （SVI）, systemic vascular resistance index （SVRI）, cardiac function index （CFI）, global ejection fraction （GEF）, extravascular lung water volume index （EVLWI）, etc.All clinical data were retrospectively analyzed.ResultsCompared with medical reference ranges, the majority of elderly patients with septic shock had low levels of CI （n=35）, SVI （n=41）, CFI （n=39） and GEF （n=46） and high levels of EVLWI （n=34）. More patients over 75 years than those under 75 years showed lower CI（n=33, or 80.5% vs.n=2, or 22.2%, χ2=13.511, P=0.001）, lower CFI （n=35, or 85.4% vs.n=4, or 44.4%, χ2=7.236, P=0.027）, and higher SVRI （n=24, or 58.5% vs.n=0 or 0.0%, χ2=10.392, P=0.006）. CI and CFI levels were negatively correlated with patient age （r=-0.460, P=0.001; r=-0.384, P=0.006）. Diabetics showed lower CFI [（2.70±0.67）L/min vs.（3.64±1.54）L/min, t=2.189, P=0.033], while patients with chronic obstructive pulmonary disease demonstrated a higher level of EVLWI[（13.83±7.60）L/min vs.（9.61±4.24）L/min, t=-2.062, P=0.045]. On the third day, patients with high levels of PVPI showed an increased rate of mortality （80.0%, or 4 out of 5 cases to 28.9%, or 13 out of 45 cases, χ2=5.239, P=0.022）, while the level of EVLWI of non-survivors was significantly higher than that of survivors on day 28[ （11.10±5.57）ml/kg vs.（8.53±2.85）ml/kg, t=-2.150, P=0.037].ConclusionsElderly patients with septic shoc

关 键 词：休克 脓毒性 血流动力学 

分 类 号：R459.7[医药卫生—急诊医学]