CAJ | 학술논문

目的：探讨难治性感染性休克患者左心室-动脉偶联的变化及其临床意义。方法选择53例难治性感染性休克患者，监测起始点及24 h点心指数（CI）、每搏指数（SVI）、左心室收缩末弹性指数（Eesl）、有效动脉弹性指数（Eal）、有效动脉弹性/左心室收缩末弹性（Ea/Ees）、动脉血乳酸（Lac）和乳酸清除率（rLac）等指标，将患者分为ΔEa/Ees>0组（n=19），ΔEa/Ees≤0组（n=34），随访28 d的患者生存情况。结果随访28 d死亡率发现，ΔEa/Ees>0组病死率为68.4%（13/19），显著高于ΔEa/Ees≤0组38.2%（13/34）（χ2=4.444，P =0.035）。ΔEa/Ees>0组rLac为（-2.6±0.3）%，ΔEa/Ees≤0组的rLac为（5.9±1.3）%，两者存在显著差异（ t =9.762，P <0.001）。ΔEa/Ees≤0组24 h CI、SVI显著高于ΔEa/Ees>0组，EaI、Ea/Ees显著低于ΔEa/Ees>0组，其余项无统计学差异。逐步Logistic回归发现，24 h点ΔEa/Ees、24 h点的APACHE II评分是影响患者28 d死亡的危险因素。结论关注难治性感染性休克中左心室-动脉偶联意义重大，可改善患者组织灌注，从而对改善预后具有重要意义。
목적：탐토난치성감염성휴극환자좌심실-동맥우련적변화급기림상의의。방법선택53례난치성감염성휴극환자，감측기시점급24 h점심지수（CI）、매박지수（SVI）、좌심실수축말탄성지수（Eesl）、유효동맥탄성지수（Eal）、유효동맥탄성/좌심실수축말탄성（Ea/Ees）、동맥혈유산（Lac）화유산청제솔（rLac）등지표，장환자분위ΔEa/Ees>0조（n=19），ΔEa/Ees≤0조（n=34），수방28 d적환자생존정황。결과수방28 d사망솔발현，ΔEa/Ees>0조병사솔위68.4%（13/19），현저고우ΔEa/Ees≤0조38.2%（13/34）（χ2=4.444，P =0.035）。ΔEa/Ees>0조rLac위（-2.6±0.3）%，ΔEa/Ees≤0조적rLac위（5.9±1.3）%，량자존재현저차이（ t =9.762，P <0.001）。ΔEa/Ees≤0조24 h CI、SVI현저고우ΔEa/Ees>0조，EaI、Ea/Ees현저저우ΔEa/Ees>0조，기여항무통계학차이。축보Logistic회귀발현，24 h점ΔEa/Ees、24 h점적APACHE II평분시영향환자28 d사망적위험인소。결론관주난치성감염성휴극중좌심실-동맥우련의의중대，가개선환자조직관주，종이대개선예후구유중요의의。
Objective To investigate the left ventricular-arterial coupling in refractory septic shock. Methods Fifty-three cases of re-fractory septic shock were collected. Cardiac index( CI),stroke volume index( SVI),left ventricular end-systolic elastance index( Eesl),ef-fective arterial elastance index( Eal),effective arterial elastance/left ventricular end-systolic elastance( Ea/Ees),arterial blood lactate( Lac) and lactate clearance rate(rLac)and other indicators were obtained at the beginning and the 24th hour of monitoring. Patients were divided intoΔEa/Ees> 0 group(n=19)andΔEa / Ees≤0 group(n= 34). The mortality rate at day 28 was obtained by follow-up. Results The mor-tality rate at day 28 in ΔEa / Ees> 0 group was 68. 4%(13/19),significantly higher than 38. 2%(13/34)in ΔEa/Ees≤0 group(χ2 =4. 444,P =0. 035). rLac inΔEa/Ees> 0 group was -2. 6 ± 0. 3%,but it was 5. 9 ± 1. 3% inΔEa/Ees≤0 group;there was a significant differ-ence between the two( t =9. 762,P <0. 001). CI and SVI at the 24th hour inΔEa/Ees≤0 group were significantly higher thanΔEa/Ees> 0 group and EaI,Ea/Ees were significantly lower than ΔEa/Ees>0 group. No significant difference was found in the remaining parameters. Step-wise logistic regression found thatΔEa/Ees and APACHE II score at the 24th hour were risk factors for the mortality at day 28 in patients. Conclu-sion The study of left ventricle-arterial coupling in refractory septic shock has great significance for improving tissue perfusion and prognosis.