影响脓毒症休克患者体液复苏后生存的因素及阻抗心输出量测量系统监测微循环血流动力学指标的意义  

Factors of affecting survival of patients with septic shock after fluid resuscitation and the significance of NICaS in monitoring hemodynamic indicators of microcirculation

作　　者：帕提古丽·木合买提 李吉明[1] Patiguli·Muhemaiti;Li Jiming(Intensive Care Unit of Emergency Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院急救中心重症监护室,乌鲁木齐830000

出　　处：《中国医学装备》2024年第11期76-80,共5页China Medical Equipment

基　　金：新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-202017)。

摘　　要：目的:探究与分析影响脓毒症休克患者体液复苏后生存的因素及阻抗心输出量测量系统(NICaS)监测微循环血流动力学指标的意义。方法:回顾性分析2020年3月至2022年3月新疆医科大学第一附属医院收治的90例脓毒症患者的临床资料,按照28 d预后生存与否分为生存组(59例)和死亡组(31例),对比两组患者血流动力学指标及心功能指标,分析脓毒症休克患者血流动力学指标、慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、心功能变化及预后的影响。结果:死亡组的APACHEⅡ评分(19.21±1.82)分,明显高于生存组的(15.68±2.31)分,组间比较差异有统计学意义(t=7.947,P<0.05)。死亡组与生存组相比心率(HR)差异无统计学意义(P>0.05)。死亡组与生存组相比,平均动脉压(MAP)较低、体循环血管阻力指数(SVRI)较高、心脏指数(CI)较低,组间差异具均有统计学意义(t=4.887、5.398、7.057,P<0.05)。死亡组与生存组比较左心室射血分数(LVEF)、左心房内径(LAD)、左心室后壁厚度(LVPWd)、室间隔厚度(IVSd)、E峰流速(E)、A峰流速(A)以及E/A值差异均无统计学意义(P>0.05)。死亡组LVEDD值高于生存组,组间比较差异有统计学意义(t=9.887,P<0.05)。将脓毒症休克患者28 d预后作为因变量,将入院第7 d后的血流动力学指标、心脏指标作为自变量,多单因素分析中存在明显差异的指标APACHEⅡ评分、MAP、SVRI、CI及LVEDD纳入到logistic回归分析方程中,结果显示APACHEⅡ评分、CI及LVEDD是影响脓毒症休克患者预后的高危独立因素(OR=1.674、0.902、1.225,P<0.05)。结论:APACHEⅡ评分、CI及LVEDD是影响脓毒症休克患者预后的高危独立因素,当脓毒症休克患者同时存在心脏收缩及舒张功能障碍时对预后影响越大;NICa S的应用可有效监测机体微循环血流动力学指标的变化。Objective:To explore and analyze the factors of affecting survival in patients with septic shock after fluid resuscitation,and the significance of noninvasive cardiovascular output monitoring system(NICaS)in monitoring hemodynamic indicators of microcirculation.Methods:A retrospective analysis was conducted on the clinical data of 90 patients with sepsis who admitted to the First Affiliated Hospital of Xinjiang Medical University from March 2020 to March 2022.According to whether occurred survival situation of the 28-day prognosis,these patients were divided into survival group(59 cases)and non-survival group(31 cases).General documents,hemodynamic indicators,and indicators of cardiac function were compared between the two groups,and the influence of hemodynamic indicators,score of Acute Physiology and Chronic Health Evaluation II(APACHE II),change and prognosis of cardiac function of patients of septic shock were analyzed.Results:The APACHE II score(19.21±1.82)of the non-survival group was significantly higher than that(15.68±2.31)of the survival group,with statistically significant difference between the two groups(t=7.947,P<0.05).There was no significant difference in heart rate(HR)between non-survival and the survival groups(P>0.05).Compared with the mean arterial pressure(MAP),systemic vascular resistance index(SVRI)and cardiac index(CI)of survival group,the MAP and CI of non-survival group were lower,and the SVRI of non-survival group was higher,and the differences of them between two groups were significant(t=4.887,5.398,7.057,P<0.05),respectively.There were no significant differences in left ventricular ejection fraction(LVEF),left atrial diameter(LAD),left ventricular posterior wall thickness(LVPWd),interventricular septal thickness(IVSd),E-peak velocity(E),A-peak velocity(A),and E/A ratio between non-survival group and survival groups(P>0.05).However,the LVEDD value of non-survival group was significantly higher than that of survival group,and the difference of that between two groups was statisticall

关 键 词：脓毒症休克 血流动力学指标 心功能 预后 非侵入性心血管监测系统(NICaS) 

分 类 号：R692[医药卫生—泌尿科学]