右室量化分析系统联合心肌损伤标志物可指导脓毒性休克患者的预后  

Right ventricular quantitative analysis system combined with myocardial injury markers can guide the prognosis of patients with septic shock

作　　者：张懿瑶 牛凯旋 吕宏安 赵士兵 ZHANG Yiyao;NIU Kaixuan;LÜHongan;ZHAO Shibing(Department of Ultrasound Medicine,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,China;Department of Critical Care Medicine,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,China)

机构地区：[1]蚌埠医科大学第一附属医院超声医学科,安徽蚌埠233004 [2]蚌埠医科大学第一附属医院重症医学科,安徽蚌埠233004

出　　处：《分子影像学杂志》2024年第11期1155-1162,共8页Journal of Molecular Imaging

基　　金：安徽省教育厅自然科学重点项目(KJ2021A0735)。

摘　　要：目的应用右室量化分析系统(RVQAS)联合心肌损伤标志物在脓毒性休克患者预后的相关性研究。方法选取2018年5月~2023年5月蚌埠医科大学第一附属医院重症医学科收治的脓毒性休克患者100例,根据患者28 d后的预后结果,分为生存组(n=76)和死亡组(n=24),使用床边超声通过RVQAS记录患者右室的定量医学参数。同时采集患者入院当天血清中相关心肌损伤标志物浓度,将上述结果纳入统计分析。结果死亡组中右心室舒张末期容积(RVEDV)、右心室舒张末期容积指数(RVEDVI)、右心室收缩末期容积(RVESV)、右心室收缩末期容积指数(RVESVI)高于生存组,死亡组中右心室射血分数(RVEF)、右心室心输出量、右心室心指数、右心室每搏输出量、右心室每搏输出量指数低于生存组(P<0.05)。死亡组血清中的肌酸激酶(CK)、肌酸激酶同工酶及心肌肌钙蛋白I(cTnI)的浓度高于生存组(P<0.05)。Spearman相关性分析结果显示,患者死亡与RVEDV、RVEDVI、RVESV、RVESVI、CK和cTnI呈正相关,与RVEF呈负相关(P<0.05)。以脓毒性休克死亡者为阳性样本,存活者为阴性样本,ROC曲线显示单个指标RVESVI诊断的曲线下面积最大为0.948,联合诊断中RVESVI联合CK诊断的曲线下面积最大为0.999,对死亡的预测价值最高。结论通过RVQAS测定患者右室功能可以为脓毒性休克患者进行及时有效的治疗提供更多参考信息,其中RVESVI联合CK对患者死亡预测价值最高,应更早应用于临床,为患者早期诊疗带来较大获益。Objective To investigate the prognostic value of right ventricular quantitative analysis system(RVQAS)combined with myocardial injury markers in patients with septic shock.Methods A total of 100 patients with septic shock admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Bengbu Medical University from May 2018 to May 2023 were selected and divided into survival group(n=76)and death group(n=24)according to the prognosis after 28 days,Quantitative medical parameters of the right ventricle of patients were recorded by RVQAS using bedside ultrasound.At the same time,the serum concentrations of myocardial injury markers on the day of admission were collected,and the above results were included in the statistical analysis.Results Right ventricular end-diastolic volume(RVEDV),Right ventricular end-diastolic volume index(RVEDVI),Right ventricular end-systolic volume(RVESV)and Right ventricular end-systolic volume index(RVESVI)in the death group were higher than those in the survival group(P<0.05).right ventricular ejection fraction(RVEF),right ventricular cardiac output,right ventricular cardiac index,right ventricular stroke volume and right ventricular stroke volume index were lower in the death group than in the survival group(P<0.05).The serum concentrations of creatine kinase(CK),creatine kinase isoenzyme and cardiac troponin I(cTnI)in the death group were higher than those in the survival group(P<0.05).Spearman correlation analysis showed that the death of patients was positively correlated with RVEDV,RVEDVI,RVESV,RVESVI,CK and cTnI,and negatively correlated with RVEF(P<0.05).The ROC curve showed that the area under the curve of RVESVI alone was 0.948,and the area under the curve of RVESVI combined with CK was 0.999 in the diagnosis of septic shock,and the predictive value of RVESVI for death was the highest.Conclusion RVQAS measurement of right ventricular function can provide more reference information for the timely and effective treatment of patients with septic shock.RVES

关 键 词：右室量化分析系统 心肌标志物 脓毒性休克 

分 类 号：R459.7[医药卫生—急诊医学]