脓毒血症并发急性心力衰竭患者血流动力学和舌下微循环指标诊断价值分析  

Analysis of diagnostic value of hemodynamics and sublingual microcirculation in patients with sepsis complicated with acute heart failure

作　　者：黄英华[1] 曾文欢 甘起云 银剑斌[2] Huang Yinghua;Zeng Wenhuan;Gan Qiyun;Yin Jianbin(Department of Emergency,Liuzhou People's Hospital,Guangxi,Liuzhou 545006,China;Department of Cardiology,Liuzhou People's Hospital,Guangxi,Liuzhou 545006,China)

机构地区：[1]柳州市人民医院急诊科,广西柳州545006 [2]柳州市人民医院心血管内科,广西柳州545006

出　　处：《中国医学前沿杂志（电子版）》2020年第9期56-60,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20180333)。

摘　　要：目的分析脓毒血症并发急性心力衰竭(心衰)患者血流动力学和舌下微循环指标与病情严重程度的相关性及其诊断价值。方法将柳州市人民医院2016年8月至2018年12月收治的脓毒血症并发急性心衰患者32例纳入观察组,将该院同期收治的脓毒血症未并发急性心衰患者32例纳入对照组。比较两组患者血流动力学指标[右心房压力(right atrial pressure,RAP)、肺动脉楔压(pulmonary arterial wedge pressure,PAWP)、心脏指数(cardiac index,CI)、平均动脉压(mean arterial pressure,MAP)]和舌下微循环指标[总血管密度(total of vessel density,TVD)、灌注血管密度(perfused vessel density,PVD)、灌注血管比率(percentage of perfused vessels,PPV)、微血管流动指数(microvascular flow index,MFI)]之间的差异,并分析各指标与脓毒血症并发急性心衰患者病情严重程度的相关性。采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析上述指标对脓毒血症并发急性心衰的诊断价值。结果观察组患者RAP和PAWP均显著高于对照组(均P<0.05),CI、MAP、TVD、PVD、PPV、MFI均显著低于对照组(均P<0.05)。PAWP、RAP与急性生理与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NT-proBNP)水平均呈显著正相关(均P<0.05),PVD、MFI与APACHEⅡ评分、SOFA评分、NT-proBNP水平均呈显著负相关(均P<0.05)。ROC曲线分析显示,RAP、PAWP、PVD和MFI诊断脓毒血症并发急性心衰的曲线下面积(area under the curve,AUC)分别为0.652、0.656、0.663和0.659,上述四项指标联合诊断脓毒血症并发急性心衰的AUC为0.854。结论血流动力学和舌下微循环指标与脓毒血症并发急性心衰严重程度具有明显相关性,可为评估患者病情变化提供参考;同时,血流动力学指标�Objective To explore the diagnostic value of hemodynamics and sublingual microcirculation in patients with sepsis complicated with acute heart failure.Method From August 2016 to December 2018,32 patients with sepsis complicated with acute heart failure treated in Liuzhou People's Hospital were included in observation group,and 32 patients with sepsis without acute heart failure treated in that hospital during the same period were included in control group.The differences of hemodynamic indexes[right atrial pressure(RAP),pulmonary arterial wedge pressure(PAWP),cardiac index(CI),mean arterial pressure(MAP)]and sublingual microcirculation indexes[total of vessel density(TVD),perfused vessel density(PVD),percentage of perfused vessels(PPV),microvascular flow index(MFI)]between the two groups were compared,and the correlation between each index and the severity of sepsis complicated with acute heart failure was analyzed.The receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic value of the above indexes in sepsis complicated with acute heart failure.Result The RAP and PAWP of observation group were significantly higher than those of control group(all P<0.05),CI,MAP,TVD,PVD,PPV and MFI were significantly lower than those of control group(all P<0.05).PAWP,RAP were positively correlated with acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)level(all P<0.05),PVD and MFI were negatively correlated with APACHEⅡscore,SOFA score and NT-proBNP level(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of RAP,PAWP,PVD and MFI in the diagnosis of sepsis complicated with acute heart failure were 0.652,0.656,0.663 and 0.659,respectively,and the AUC of the combination of the above four indexes in the diagnosis of sepsis complicated with acute heart failure was 0.854.Conclusion The indexes of hemodynamics and sublingual microcirculation are significantly correlate

关 键 词：脓毒血症 急性心力衰竭 血流动力学 舌下微循环 诊断价值 

分 类 号：R459.7[医药卫生—急诊医学] R541.6[医药卫生—治疗学]