心室动脉偶联与脓毒症患者血流动力学的关系及对预后的预测价值  

Relationship between ventricular arterial coupling and haemodynamics in patients with sepsis and its predictive value for prognosis

作　　者：凡永军 刘文芳 卢亚超 FAN Yongjun;LIU Wenfang;LU Yachao(Department of General Practice,Baoding No.2 Hospital,Baoding 071000,China;Department of Endocrinology,Baoding Children's Hospital)

机构地区：[1]保定市第二医院全科医学科,071000 [2]保定市儿童医院内分泌科

出　　处：《天津医药》2025年第4期402-406,共5页Tianjin Medical Journal

基　　金：2021年度河北省医学科学研究课题计划(20210201)。

摘　　要：目的探讨心室动脉偶联(VAC)与脓毒症患者血流动力学的关系及其对患者28 d预后的预测价值。方法选取脓毒症患者164例,给予液体复苏(3 h内输注30 mL/kg的晶体液)治疗并观察其复苏0 h、24 h、72 h的VAC[有效主动脉弹性(Ea)/心室收缩末期弹性(Ees)]及血流动力学参数变化情况,计算复苏24 h、72 h与0 h之间的差值24 hΔEa/Ees、72 hΔEa/Ees,采用Pearson法分析Ea/Ees与Δ中心静脉压(CVP)、Δ心搏出量指数(SVI)及Δ心脏指数(CI)的相关性。根据28 d预后分为存活组(123例)和死亡组(41例),收集2组患者一般资料,采用多因素Cox回归模型及受试者工作特征(ROC)曲线分析患者28 d死亡的影响因素及24 hΔEa/Ees、72 hΔEa/Ees对预后的预测价值。结果164例患者复苏24 h、72 h的Ea/Ees低于0 h,且72 h的Ea/Ees低于24 h(均P<0.05),164例患者复苏24 h、72 h的CVP、SVI、CI均高于0 h,且24 h的CVP、SVI、CI高于72 h(均P<0.05);24 hΔEa/Ees低于72 hΔEa/Ees(P<0.05),24 hΔCVP、ΔSVI、ΔCI高于72 h对应指标(P<0.05);24 hΔEa/Ees与24 hΔCVP、24 hΔSVI、24 hΔCI呈负相关(P<0.05);死亡组急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)≥20分、序贯器官衰竭评分(SOFA)≥10分占比以及24 hΔEa/Ees、72 hΔEa/Ees均高于存活组(P<0.05);APACHEⅡ、SOFA、24 hΔEa/Ees以及72 hΔEa/Ees升高均为影响脓毒症患者28 d预后不良的危险因素(P<0.05);24 hΔEa/Ees、72 hΔEa/Ees对脓毒症患者28 d预后预测效能较好(P<0.05)。结论Ea/Ees变化情况能较好地反映脓毒症患者治疗早期血流动力学改变,有助于预测脓毒症患者28 d预后。Objective To investigate the relationship between ventricular arterial coupling(VAC)and haemodynamics of patients with sepsis and the predictive value for the 28-day prognosis.Methods A total of 164 patients with sepsis were selected and given fluid resuscitation treatment(infusion of 30 mL/kg of crystalloid over 3 h),and changes of VAC[effective aortic elasticity(Ea)/ventricular end-systolic elasticity(Ees)]values and hemodynamic parameters of patients resuscitated for 0 h,24 h and 72 h were observed.The difference between Ea/Ees for 24 h and 72 h of resuscitation and 0 h was calculated.Pearson method was used to analyze the correlation between Ea/Ees andΔcentral venous pressure(CVP),Δspiratory volume index(SVI)andΔcardiac index(CI).According to the 28-day prognosis,patients were divided into two groups:the survival group(123 cases)and the death group(41 cases).General information was collected in two groups of patients.The predictive values of 24 hΔEa/Ees and 72 hΔEa/Ees for 28-day death in sepsis patients were analyzed by multivariate Cox regression models and receiver operating characteristics(ROC)curve.Results The Ea/Ees of 164 patients resuscitated for 24 h and 72 h were lower than those of 0 h,and the Ea/Ees of 72 h was lower than that of 24 h(all P<0.05).CVP,SVI and CI of 164 patients resuscitated for 24 h and 72 h were higher than those of 0 h,and the CVP,SVI and CI of 24 h was higher than that of 72 h(all P<0.05).The 24 hΔEa/Ees was significantly lower than that of 72 hΔEa/Ees(P<0.05),and 24 hΔCVP,SVI and CI were higher than those of 72 h(P<0.05).There was a negative correlation between 24 hΔEa/Ees and 24 hΔCVP,24 hΔSVI and 24 hΔCI(P<0.05).Acute Physiology and Chronic Health Status Score II(APACHE II)≥20 points,Sequential Organ Failure Score(SOFA)≥10 points,24 hΔEa/Ees and 72 hΔEa/Ees were higher in the death group than those in the survival group(P<0.05).Elevated APACHE II,SOFA,24 hΔEa/Ees and 72 hΔEa/Ees were risk factors affecting the 28-day prognosis of patients with sepsis(P<0.0

关 键 词：脓毒症 血流动力学 预后 心室动脉偶联 

分 类 号：R631[医药卫生—外科学]