心室-动脉耦联指数对创伤失血性休克病人的预后影响:一项单中心队列研究  

The prognostic impact of ventricular arterial coupling in patients with traumatic hemorrhagic shock:a single center cohort study

作　　者：倪逊 陆姗姗 张驰 丁婷婷 林爱华 NI Xun;LU Shanshan;ZHANG Chi;DING Tingting;LIN Aihua(Intensive Care Unit,the Affiliated Suqian Hospital of Xuzhou Medical University/Nanjing Drum Tower Hospital Group Suqian Hospital,Suqian 223800,China;不详)

机构地区：[1]徐州医科大学附属宿迁医院/南京鼓楼医院集团宿迁医院重症医学科,江苏宿迁223800 [2]徐州医科大学附属宿迁医院/南京鼓楼医院集团宿迁医院神经内科,江苏宿迁223800 [3]徐州医科大学附属宿迁医院/南京鼓楼医院集团宿迁医院肾脏内科,江苏宿迁223800

出　　处：《临床外科杂志》2024年第12期1326-1329,共4页Journal of Clinical Surgery

基　　金：江苏省宿迁市指导性科技计划项目(Z2022059)。

摘　　要：目的探讨心室-动脉耦联(ventricular arterial coupling,VAC)指数对创伤失血性休克(hemorrhagic traumatic shock,HTS)病人预后的影响。方法2020年1月~2022年12月间我院急诊和重症医学科住院的HTS病人60例,根据预后情况分为存活组(30例)和死亡组(30例),分别对两组病人的急性生理与慢性健康评分Ⅱ(Acute Physiology and Chronic Health ScoreⅡ,APACHEⅡ)、序贯器官衰竭评分(Sequential Organ Failure Assessment,SOFA)、乳酸(lactic acid,Lac)、中心静脉血氧饱和度(central venous blood oxygen saturation,ScvO_(2))进行监测,在脉搏指示器连续心输出量(pulse index continuous cardiac output,PiCCO)监测下,比较两组病人的中心静脉压(central venous pressure,CVP)、心脏指数(cardiac index,CI)、每搏输出量指数(stroke volume index,SVI)、全心舒张末期容积指数(global end-diastolic volume index,GEDVI)、体循环血管阻力指数(systemic vascular resistance index,SVRI)、平均动脉压(mean arterial pressure,MAP),并计算出VAC指数。结果存活组和死亡组Lac水平分别为(2.31±1.29)mmol/L和(3.98±1.01)mmol/L,两组比较差异有统计学意义(P<0.05);存活组和死亡组ScvO_(2)分别为(62.69±5.73)%,(60.3±5.35)%,两组比较差异无统计学意义(P>0.05);存活组较死亡组APACHEⅡ评分[(18.57±2.23)分vs(23.00±3.15)分]、SOFA评分[(9.40±2.15)分vs(14.07±2.26)分]降低,差异有统计学意义(P<0.05),CI[(2.97±0.20)L/(min·m^(2))vs(2.73±0.27)L/(min·m^(2))]升高、SVI[(50.11±4.31)ml/m^(2)vs(46.53±3.49)ml/m^(2))]升高、VAC[(1.34±0.19)vs(1.69±0.28)]降低,两组比较差异有统计学意义(P<0.05),存活组与死亡组的CVP[(9.19±1.20)mmHg vs(9.35±1.53)mmHg]、GEDVI[(715.73±101.72)ml/m^(2)vs(717.93±89.07)ml/m^(2)]、SVRI[(2061.55±701.23)dyn·sec·cm^(-5)·m^(-2)vs(2164.31±732.16)dyn·sec·cm^(-5)·m^(-2))、MAP[(92.21±10.81)mmHg vs(89.19±17.33)mmHg]比较,差异无统计学意义(P>0.05);Logistic回归分析显示,VAC(OR=1.41)、Lac(OR=1.36)、APACHEⅡ评分(ORObjective To explore the impact of ventricular arterial coupling on the prognosis of patients with traumatic hemorrhagic shock(HTS).Methods 60 HTS patients who were hospitalized in the emergency and critical care departments of Nanjing Drum Tower Hospital Group Suqian Hospital from January 2020 to December 2022 were included.They were divided into survival group(n=30)and death group(n=30)based on their prognosis.The acute physiological and chronic health scoreⅡ(APACHEⅡ),sequential organ failure(SOFA)score,lactate(Lac),and central venous oxygen saturation(ScvO_(2))of the two groups of patients were monitored,respectively,Compare the central venous pressure(CVP),cardiac index(CI),stroke volume index(SVI),global end diastolic volume index(GEDVI),systemic vascular resistance index(SVRI),and mean arterial pressure(MAP)of two groups of patients under continuous monitoring of pulse indicator cardiac output(PiCCO),and calculate the left ventricular arterial coupling(VAC)index.Results The Lac levels in the survival group and death group were(2.31±1.29)mmol/L and(3.98±1.01)mmol/L,respectively,with statistical significance(P<0.05);The ScvO_(2)values for the survival group and death group were(62.69±5.73)%and(60.3±5.35)%,respectively,with no significant statistical difference(P>0.05);The survival group showed a statistically significant decrease in APACHEⅡscore[(18.57±2.23)points vs(23.00±3.15)points]and SOFA score[(9.40±2.15)points vs(14.07±2.26)points]compared to the death group(P<0.05),with an increase in CI[(2.97±0.20)L/(min·m^(2))vs(2.73±0.27)L/(min·m^(2))],an increase in SVI[(50.11±4.31)ml/m^(2)vs(46.53±3.49)ml/m^(2)],and a decrease in VAC[(1.34±0.19)vs(1.69±0.28)],and a statistically significant difference(P<0.05),However,there was no significant statistical difference in CVP[(9.19±1.20)mmHg vs(9.35±1.53)mmHg)],GEDVI[(715.73±101.72)ml/m^(2)vs(717.93±89.07)ml/m^(2)],SVRI[(2061.55±701.23)dyn·sec·cm^(-5)·m^(-2) vs(2164.31±732.16)dyn·sec·cm^(-5)·m^(-2)],and MAP[(92.21±10.81)mmHg vs(89.19

关 键 词：创伤失血性休克 心室-动脉耦联 持续心输出量监测 

分 类 号：R54[医药卫生—心血管疾病]