左心室动脉偶联与左心做功在感染性休克中的关系及其对患者预后的意义  

The relationship between left ventricular artery coupling and left ventricular work and their predictive value on prognosis in septic shock

作　　者：周高生 刘晶晶 张宏民 张青 王小亭 刘大为 Zhou Gaosheng;Liu Jingjing;Zhang Hongmin;Zhang Qing;Wang Xiaoting;Liu Dawei(Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100710,China)

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,北京100710

出　　处：《中华医学杂志》2022年第47期3749-3755,共7页National Medical Journal of China

基　　金：首都临床诊疗技术研究及转化应用项目(Z201100005520038)。

摘　　要：目的探寻左心室动脉偶联与左心做功在感染性休克患者中的关系,明确二者对感染性休克预后的预测价值。方法回顾性分析2016年1月1日至2021年7月31日北京协和医院重症医学科56例感染性休克患者的临床资料。收集不同时间点脉搏指示连续心排血量技术(PICCO)监测血流动力学指标及临床资料,揭示在不同时间点感染性休克患者动脉弹性指数(EaI)、左心室收缩末弹性指数(EesI)、EaI/EesI、心脏每搏功(SW)、心脏总功(PVA)、左心室射血效率(LVEf)的变化规律。根据重症监护病房(ICU)结局将患者分为死亡组(n=20)和存活组(n=36),分析两组患者在不同时间点左心室做功及左心室-动脉偶联的关系及其预后价值。结果共纳入56例感染性休克患者,男32例,女24例,年龄(61±15)岁。死亡组及生存组EaI/EesI、LVEf在入ICU 6 h差异均有统计学意义(均P<0.05)。进一步分析发现干预6 h后左心室动脉偶联与左心做功的相关性最明显,EaI/EesI与SW呈中度负相关(rs=-0.500,P<0.001),与LVEf呈高度负相关(rs=-0.959,P<0.001)。单因素logistic回归及多因素回归分析均显示EaI/EesI(校正OR=42.783,95%CI:2.725~671.819,P=0.008)、LVEf(校正OR=2.293,95%CI:1.222~4.301,P=0.010)是感染性休克患者住院预后的危险因素。受试者工作特征(ROC)曲线分析提示EaI/EesI[曲线下面积(AUC)=0.742±0.083,P=0.004]、LVEf(AUC=0.733±0.084,P=0.006)均是预测感染性休克患者ICU预后的有效指标,其中EaI/EesI预测感染性休克患者预后的最佳cut-off值为6.10,灵敏度为88.9%,特异度为65.0%;LVEf预测感染性休克患者预后的最佳cut-off值为0.24,灵敏度为88.8%,特异度为60.0%;EaI/EesI预测效能大于LVEf(ΔAUC=0.120,Z=6.528,P=0.036)。结论感染性休克干预6 h后,EaI/EesI与SW、LVEf明显相关;EaI/EesI、LVEf是感染性休克患者ICU预后的危险因素及有效预测指标,EaI/EesI预测效能大于LVEf。Objective To explore the relationship between left ventricular artery coupling and left ventricular work in patients with septic shock,and further clarified their predictive value for the prognosis of septic shock.Methods In total,56 patients with septic shock admitted in the Department of Critical Care Medicine of Peking Union Medical College Hospital were retrospectively enrolled between January 2016 and July 2021.The hemodynamic indexes and clinical data monitored by pulse indicator continuous cardiac output(PICCO)at different time points were collected.To reveal alterations of arterial elastance index(EaI),end-systolic elastance index(EesI),EaI/EesI,stroke work(SW),total cardiac function(PVA),and left ventricular ejection efficiency(LVEf)in patients with septic shock at different time points.The patients were divided into the death group(n=20)and survival group(n=36)according to the outcome of the ICU.The relationship between left ventricular work and left ventricular arterial coupling and its prognostic value were statistically analyzed.Results A total of 56 patients were enrolled,32 males and 24 females,aged(61±15)years.There was a significantly difference in EaI/EesI and LVEf between survivors and non-survivors with septic shock at 6 h(P<0.05).Further analysis showed that the correlation between EaI/EesI and LVEf was most evident at 6 h after intervention.EaI/EesI was negatively correlated with SW(rs=-0.500,P<0.001),and highly negative with LVEf(rs=-0.959,P<0.001).Both univariate logistic regression and multivariate regression analysis showed that EaI/EesI(adjusted OR=42.783,95%CI:2.725-671.819,P=0.008)and LVEf(adjusted OR=2.293,95%CI:1.222-4.301,P=0.010)were risk factors for ICU prognosis of patients with septic shock.The receiver operating characteristic(ROC)curve analysis showed that EaI/EesI[area under the curve(AUC)=0.742±0.083,P=0.004;cut-off value 6.10,sensitivity 88.9%,specificity 65.0%]and LVEf(AUC=0.733±0.084,P=0.006;cut-off value 0.24,sensitivity 88.8%,specificity 60.0%)were both effective in

关 键 词：休克 脓毒性 左心室动脉偶联 左心室每搏功 左心室总功 左心室射血效率 脉搏指示连续心输出量监测 

分 类 号：R459.7[医药卫生—急诊医学]