脉波指示持续心排血量血流动力学和动脉血乳酸监测在感染性休克血液灌流治疗中的应用价值  

Values of pulse indicator continuous cardiac output hemodynamics and arterial blood lactic acid indexes in hemoperfusion treatment of patients with septic shock

作　　者：孙一夫 王韫文 姜艳[1] SUN Yi-fu;WANG Yun-wen;JIANG Yan(Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院急诊科,辽宁沈阳110004

出　　处：《中华医院感染学杂志》2023年第7期976-980,共5页Chinese Journal of Nosocomiology

基　　金：辽宁省自然科学基金资助项目(2019Y752)。

摘　　要：目的分析感染性休克患者病原学特点及脉波指示持续心排血量(PiCCO)血流动力学、动脉血乳酸在血液灌流治疗中的监测价值。方法选取2019年7月-2021年7月医院收治的91例感染性休克患者为研究对象,收集所有研究对象的临床资料,随访患者入住急诊重症监护室(EICU)后28 d预后情况,并根据患者预后情况将其分为存活组(52例)和死亡组(39例)。监测入住EICU后0、6、24 h时的PiCCO血流动力学及动脉血乳酸指标水平。采用受试者工作特征(ROC)曲线分析PiCCO血流动力学指标及血乳酸水平对感染性休克患者预后的预测价值,曲线下面积(AUC)表示预测的准确度;采用多因素Logistic回归分析法分析预后影响因素。结果对患者进行病原学检测,共检出病原菌91株,其中革兰阴性菌67株(73.63%)、革兰阳性菌22株(24.18%)、真菌2株(2.20%)。存活组在24 h时的CO指标高于死亡组,而SVRI、EVLWI及PVPI指标低于死亡组(P<0.05)。存活组在6、24 h时的血乳酸指标水平低于死亡组(P<0.05)。24 h CO、24 h SVRI、24 h EVLWI、6 h血乳酸及24 h血乳酸指标用于感染性休克患者预后预测的AUC值分别为0.876、0.846、0.877、0.797、0.836,各指标间AUC值比较差异无统计学意义。Logistic回归分析结果显示,24 h CO≤4.21 L/min、24 h SVRI>2179.2 mmHg·min/L·m^(2)、24 h EVLWI>8.05 ml/kg、6 h血乳酸>4.36 mmol/L、24 h血乳酸>2.43mmol/L是感染性休克患者血液灌流治疗预后不良的独立影响因素(P<0.05)。结论监测感染性休克患者血液灌流治疗期间的PiCCO血流动力学和乳酸指标水平对于预测患者预后可能具有积极意义。OBJECTIVE To analyze etiological characteristics and monitoring value of pulse indicator continuous cardiac output(PiCCO)hemodynamics and lactic acid in hemoperfusion of patients with septic shock.METHODS A total of 91 patients with septic shock admitted to the hospital between Jul 2019 and Jul 2021 were enrolled as the research subjects,and their clinical data were collected.According to prognosis at 28 d after admission to emergency intensive care unit(EICU),they were divided into the survival group(52 cases)and death group(39 cases).The levels of PiCCO hemodynamics and arterial blood lactic acid were monitored at 0,6 and 24 h after admission to EICU,and their predictive value for prognosis of patients with septic shock was explored by receiver operating characteristic(ROC)curves analysis.The area under the curve(AUC)represented predictive accuracy.The influencing factors for prognosis were analyzed by multivariate logistic regression analysis.RESULTS Etiological detection showed that there were 91 strains of pathogens,including 67 strains of gram-negative bacteria(73.63%),22 strains of gram-positive bacteria(24.18%)and 2 strains of fungi(2.20%).At 24h after admission to EICU,concentration of CO in the survival group was higher than that in the death group,while SVRI,EVLWI and PVPI were lower than those in the death group(P<0.05).At 6h and 24h after admission to EICU,levels of blood lactic acid indexes in the survival group were lower than those in death group(P<0.05).AUC values of 24 h CO,24 h SVRI,24 h EVLWI,6 h blood lactic acid and 24 h blood lactic acid for predicting prognosis of patients with septic shock were 0.876,0.846,0.877,0.797 and 0.836,respectively,and the difference was not statistically significant.The results of logistic regression analysis showed that 24 h CO≤4.21 L/min,24 h SVRI>2179.2 mmHg·min/L·m^(2),24h EVLWI>8.05 ml/kg,6 h blood lactic acid>4.36 mmol/L and 24 h blood lactic acid>2.43 mmol/L were independent risk factors for poor prognosis in patients with septic shock during hemoperf

关 键 词：感染性休克 病原学 血液灌流 脉波指示持续心排血量 动脉血乳酸 受试者工作特征曲线 脉波指示持续心排血量血流动力学 监测 

分 类 号：R541.64[医药卫生—心血管疾病]