感染性休克病原学及经胸超声参数与其容量反应性、NE减量后MAP反应性的关系  

Etiological characteristics of septic shock and association of transthoracic echocardiography parameters with volume responsiveness,MAP responsiveness after NE reduction

作　　者：陈思佳 王益斐 傅晓凤 孙铭芳 钱美丽 覃超 CHEN Si-jia;WANG Yi-fei;FU Xiao-feng;SUN Ming-fang;QIAN Mei-li;QIN Chao(Zhuji Hospital of Traditional Chinese Medicine,Zhuji,Zhejiang 311800,China)

机构地区：[1]诸暨市中医医院超声科,浙江诸暨311800 [2]诸暨市中医医院重症医学科,浙江诸暨311800

出　　处：《中华医院感染学杂志》2023年第5期688-692,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2021RC137)。

摘　　要：目的探究感染性休克病原学特点及经胸超声参数与其容量反应性、去甲肾上腺素(NE)减量后平均动脉压(MAP)反应性的关系。方法以2018年1月-2020年12月诸暨市中医医院98例感染性休克患者为研究对象。根据快速扩容后被动抬腿试验心指数(CI)增值分为容量反应性组(CI增值>10%)及容量无反应性组(CI增值≤10%),根据NE减量后平均动脉压(MAP)变化分为MAP反应性组(MAP增值>15%)及MAP无反应性组(MAP增值≤15%),比较彩超下血流动力学参数及联合检测对感染性休克患者快速扩容及NE减量反应性的评估价值。结果98例感染性休克患者中共检出病原菌105株,以革兰阴性菌为主,其中大肠埃希菌占比最高为23.81%;容量反应性组扩容前下腔静脉呼吸变异率(△IVC)、主动脉峰值流速呼吸变异率(△VpekAO)、肱动脉最大速度变异率(△VpekBA)高于容量无反应性组(P<0.05);MAP反应性组NE减量前△IVC、△VpekAO、△VpekBA高于MAP无反应性组,心率(HR)值小于MAP无反应性组(P<0.05);HR、△IVC、△VpekAO、△VpekBA联合检测评估快速扩容容量反应性及NE减量后MAP反应性的曲线下面积(AUC)大于各指标单独检测(P<0.05)。结论大肠埃希菌、肺炎克雷伯菌是感染性休克的主要致病菌,且血流动力学参数联合检测对感染性休克患者快速扩容及NE减量反应性具有评估价值。OBJECTIVE To explore the etiological characteristics of septic shock and analyze the association of transthoracic echocardiography parameters with volume responsiveness and mean arterial pressure(MAP)responsiveness after norepinephrine(NE)reduction.METHODS A total of 98 patients with septic shock who were treated in Zhuji Hospital of Traditional Chinese Medicine from Jan 2018 to Dec 2020 were recruited as the research subjects and were divided into the volume responsiveness group with CI increment more than 10%and the volume no responsiveness group with CI increment no more than 10%according to the increment of cardiac index(CI)in passive leg raising test after rapid dilatation,the patients were divided into the MAP responsiveness group with MAP increment more than 15%and the MAP no responsiveness group with MAP increment no more than 15%.The hemodynamics parameters under color ultrasound were observed and compared,and the values of single and joint detection of the indexes in assessment of rapid dilatation and NE reduction responsiveness in the septic shoch patients were analyzed.RESULTS Totally 105 strains of pathogens were isolated from the 98 patients with septic shock,among which gram-negative bacteria were dominant,Escherichia coli accounted for 23.81%.The△IVC,△VpekAO and△VpekBA of the volume responsiveness group were significantly higher than those of the volume no responsiveness group before the dilatation(P<0.05).The△IVC,△VpekAO and△VpekBA of the MAP responsiveness group were significantly higher than those of the MAP no responsiveness group before the NE reduction,the HR value of the MAP responsiveness group was significantly less than that of the MAP no responsiveness group(P<0.05).The AUC of the joint detection of HR,△IVC,△VpekAO,and△VpekBA was significantly larger than that of the single detection of the indexes in assessment of volume responsiveness of rapid dilatation and MAP responsiveness after NE reduction(P<0.05).CONCLUSION E.coli and Klebsiella pneumoniae are the predominant

关 键 词：感染性休克 病原学 耐药性 血流动力学 快速扩容 去甲肾上腺素减量 经胸超声 平均动脉压反应性 

分 类 号：R631.4[医药卫生—外科学]