静动脉血二氧化碳分压差对心肌梗死射血分数的预测价值  

Predictive value of Pcv-aCO_(2)on left ventricular ejection fraction in myocardial infarction

作　　者：杨超 林洁[2] 林春锦[3] 项国剑 刘林伟 史婷婷 郑永红[4] Yang Chao;Lin Jie;Lin Chunjin;Xiang Guojian;Liu Linwei;Shi Tingting;Zheng Yonghong(Fujian Provincial Clinical College,Fujian Medical University,Department of Critical Care Medicine IV,Fujian Provincial Hospital,Fuzhou 350001,China;Fujian Provincial Clinical College,Fujian Medical University,Department of Ultrasound,Fujian Provincial Hospital,Fuzhou 350001,China;Fujian Provincial Clinical College,Fujian Medical University,Department of Geriatrics,Fujian Provincial Hospital,Fuzhou 350001,China;Fujian Provincial Clinical College,Fujian Medical University,Department of Cardiology,Fujian Provincial Hospital,Fuzhou 350001,China;College of Integrated Traditional Chinese and Western Medicine,Fujian University of Chinese Medicine,Fuzhou 350122,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院重症医学四科,福州350001 [2]福建医科大学省立临床医学院,福建省立医院超声科,福州350001 [3]福建医科大学省立临床医学院,福建省立医院老年医学科,福州350001 [4]福建医科大学省立临床医学院,福建省立医院心内科,福州350001 [5]福建中医药大学中西医结合学院,福州350122

出　　处：《中华急诊医学杂志》2023年第5期667-673,共7页Chinese Journal of Emergency Medicine

基　　金：福建医科大学起航基金(2020QH1149);福建省自然科学基金面上项目(2017J01252);福建省重症医学中心建设项目(2017-510)。

摘　　要：目的观察急性心肌梗死的中心静脉-动脉血二氧化碳分压差(central venous-arterial blood carbon dioxide partial pressure difference,Pcv-aCO_(2))与左心室射血分数(left ventricle ejection fraction,LVEF)的关系。方法回顾性分析2019年11月至2021年10月福建省立医院重症监护病房收治的急性心肌梗死患者的临床资料。经床旁超声心动图测量LVEF。按LVEF将上述患者分为LVEF正常组(LVEF≥52%)和LVEF下降组(LVEF<52%)。比较两组患者的一般资料和血流动力学指标的差异。通过Jarque-Bera检验法对上述资料进行正态性检验。对血流动力学指标与LVEF进行相关性分析。采用二元Logistic回归分析LVEF下降的危险因素。采用受试者工作特征(ROC)曲线评估应用Pcv-aCO_(2)诊断LVEF下降的可行性。结果纳入72例急性心肌梗死患者进行分析,LVEF正常组25例,LVEF下降组47例。LVEF下降组的Pcv-aCO_(2)高于LVEF正常组[(7.13±1.19)mmHg vs.(5.41±1.23)mmHg,P<0.01]。LVEF和Pcv-aCO_(2)呈负相关关系(rs=-0.740,P<0.01);Pcv-aCO_(2)的ROC曲线下面积为0.849(95%CI:0.758~0.939,P<0.01)。二元Logistic回归分析显示Pcv-aCO_(2)是LVEF下降的独立危险因素(OR=2.251,95%CI:1.326~3.820)。结论Pcv-aCO_(2)增大在一定程度上能够预测急性心肌梗死的LVEF下降。Objective To investigate the relationship between central venous-arterial blood carbon dioxide partial pressure difference(Pcv-aCO_(2))and left ventricular ejection fraction(LVEF)in acute myocardial infarction.Methods Clinical data of patients with acute myocardial infarction admitted to the Intensive Care Unit of Fujian Provincial Hospital from November 2019 to October 2021 were retrospectively analyzed.LVEF was measured by bedside echocardiogram.The patients were divided into the normal LVEF group(LVEF≥52%)and decreased LVEF group(LVEF<52%)according to LVEF.The differences in general information and hemodynamic parameters between the two groups were compared.The normality of the above data was tested by the Jarque-Bera test.Correlation analysis of hemodynamic indices with LVEF was performed.Binary logistic regression was used to analyze the risk factors associated with the decrease in LVEF.The feasibility of diagnosing LVEF decline with Pcv-aCO_(2)was assessed using receiver operating characteristic(ROC)curve.Results Seventy-two patients with acute myocardial infarction were included for analysis,including 25 patients in the normal LVEF group and 47 patients in the decreased LVEF group.Pcv-aCO_(2)was significantly higher in the decreased LVEF group than that in the normal LVEF group[(7.13±1.19)mmHg vs.(5.41±1.23)mmHg,P<0.01].There was a negative correlation between LVEF and Pcv-aCO_(2)(rs=-0.740,P<0.01).The area under the ROC curve for Pcv-aCO_(2)was 0.849(95%CI:0.758-0.939,P<0.01).The binary logistic regression analysis showed that Pcv-aCO_(2)was an independent risk factor for decreased LVEF(OR=2.251,95%CI:1.326-3.820).Conclusions To a certain extent,the increase of Pcv-aCO_(2)can predict the decrease of LVEF in acute myocardial infarction.

关 键 词：中心静脉-动脉血二氧化碳分压差 射血分数 急性心肌梗死 乳酸 中心静脉血氧饱和度 

分 类 号：R542.22[医药卫生—心血管疾病]