中心静脉压对脓毒性休克液体过负荷患者反向液体复苏心排出量增加的影响  

The effect of central venous pressure on the increase of cardiac output in patients with septic shock and fluid overload during reverse fluid resuscitation

作　　者：张晓曦 李科[1] 许东明[1] ZHANG Xiaoxi;LI Ke;XU Dongming(Department of Emergency,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京100050

出　　处：《西部医学》2024年第12期1767-1772,共6页Medical Journal of West China

基　　金：北京市卫生健康委科研项目(2019-720)。

摘　　要：目的 探讨中心静脉压对脓毒性休克液体过负荷患者反向液体复苏心排出量增加的影响,为优化临床液体管理提供指导。方法 回顾性收集2018—2023年在我院就诊的脓毒性休克患者215例为观察对象,根据患者心排出量值是否增加,判断其反向液体复苏是否成功,以此为基准分组。并对可能影响心排出量增加的指标进行了统计分析,进一步评估了这些指标与反向液体复苏后心排出量增加的相关性,并进行主效应分析,利用Logistic方程、有序回归分析、多因子降维法,限制性立方样条模型分析反向液体复苏成功的相关因素。最后对纳入患者进行随访调查,构建生存曲线,分析不同中心静脉压下患者的预后情况。结果 本研究中复苏成功患者为134例(复苏成功组),复苏失败患者为81例(复苏失败组)。两组患者在高血压病史、左室射血分数、中心静脉压、下腔静脉宽度以及右心与左心的比例等方面,差异具有统计学意义(P<0.05)。主效应分析揭示了中心静脉压和左心/右心比例与治疗时间之间存在显著的交互作用。通过Logistic方程分析,中心静脉压与反向液体复苏成功有显著正相关关系(P<0.05)。多因子降维法的交互作用模型分析表明,中心静脉压和右心与左心比例是预测脓毒性休克患者反向液体复苏成功率的关键因素(P<0.05)。限制性立方样条分析未发现这些因素与反向液体复苏成功之间存在显著的非线性关系(P>0.05);生存曲线分析结果显示,中心静脉压水平较高的患者具有更良好的预后表现(P<0.05)。结论 中心静脉压在脓毒性休克患者反向液体复苏中的重要性,为临床实践中提高复苏成功率提供了有价值的参考依据。Objective To quantify the central venous pressure(CVP)in individuals experiencing septic shock,evaluate the effects of retrograde fluid resuscitation on cardiac output under conditions of fluid overload,and investigate the significance of CVP in this context.The findings aim to inform and improve clinical practices related to fluid management strategies.Methods A retrospective collection of clinical data was conducted on 215 patients with septic shock who visited our hospital from 2018 to 2023.The data were analyzed based on whether there was an increase in cardiac output to determine the success of reverse fluid resuscitation,which served as the basis for grouping.Statistical analysis was performed on indicators that could potentially affect the increase in cardiac output,further assessing the correlation of these indicators with the increase in cardiac output after reverse fluid resuscitation.Principal effect analysis was conducted,and logistic regression,ordinal regression analysis,multifactor dimensionality reduction method,and restricted cubic spline model were used to analyze the factors related to the success of reverse fluid resuscitation.Finally,follow-up surveys were conducted on the included patients,survival curves were constructed,and the prognosis of patients under different central venous pressures was analyzed.Results In this study,there were 134 cases of successful resuscitation and 81 cases of failed resuscitation.Significant statistical differences were found between the two groups in aspects such as history of hypertension,left ventricular ejection fraction,central venous pressure,inferior vena cava width,and the ratio of right to left heart.Principal effect analysis revealed significant interactions between central venous pressure and the ratio of right to left heart with treatment time.Logistic regression analysis showed a significant positive correlation between central venous pressure and the success of reverse fluid resuscitation.The interaction model analysis using the multifactor dimens

关 键 词：中心静脉压 脓毒性休克 反向液体复苏 心排出量 

分 类 号：R631.4[医药卫生—外科学]