中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
35期
2778-2781
,共4页
王小亭%李素玮%柴文昭%陈秀凯%张宏民%刘大为
王小亭%李素瑋%柴文昭%陳秀凱%張宏民%劉大為
왕소정%리소위%시문소%진수개%장굉민%류대위
休克,脓毒性%感染%血液灌注%血管麻痹
休剋,膿毒性%感染%血液灌註%血管痳痺
휴극,농독성%감염%혈액관주%혈관마비
Shock,septic%Infection%Hemoperfusion%Vascular paralysis
目的 探讨感染性休克患者血管麻痹对预后及组织灌注的影响.方法 回顾分析2010年1月至2011年7月北京协和医院重症医学科连续收治的感染性休克患者73例.根据28 d生存状况分存活组和死亡组,记录初始血流动力学参数、动脉血乳酸、APACHEⅡ评分及28 d生存状况.结果 死亡组初始急性生理学与慢性健康(APACHE)Ⅱ评分高于存活组,(14.6±5.6)分比(20.4±4.8)分,P＜0.01；每搏外周血管阻力指数(SSVRI) (212.7 ±52.6)比(185.4 ±50.5)、脉压每搏指数比值(PP/SVI) (2.8 ±0.7)比(2.5±0.6),有效主动脉弹性指数(EaI)(5.0±1.2)比(4.3±1.1),24、72 h乳酸清除率(rLac)以及7 rLac均显著低于存活组,(18.4±46.4)比(21.5 ±49.7),(19.9±49.6)比(-21.5 ±46.3),(35.5±45.8)比(-59.5 ±64.5),P＜0.05.SVRI,SSVRI,PP/SVI及EaI均与24、72 rLac及7 rLac相关,P＜0.01.结论 感染性休克患者血管麻痹时,SVRI,SSVRI,PP/SVI及EaI与预后及组织灌注相关,其中SSVRI,PP/SVI及EaI相关性更强.
目的 探討感染性休剋患者血管痳痺對預後及組織灌註的影響.方法 迴顧分析2010年1月至2011年7月北京協和醫院重癥醫學科連續收治的感染性休剋患者73例.根據28 d生存狀況分存活組和死亡組,記錄初始血流動力學參數、動脈血乳痠、APACHEⅡ評分及28 d生存狀況.結果 死亡組初始急性生理學與慢性健康(APACHE)Ⅱ評分高于存活組,(14.6±5.6)分比(20.4±4.8)分,P＜0.01；每搏外週血管阻力指數(SSVRI) (212.7 ±52.6)比(185.4 ±50.5)、脈壓每搏指數比值(PP/SVI) (2.8 ±0.7)比(2.5±0.6),有效主動脈彈性指數(EaI)(5.0±1.2)比(4.3±1.1),24、72 h乳痠清除率(rLac)以及7 rLac均顯著低于存活組,(18.4±46.4)比(21.5 ±49.7),(19.9±49.6)比(-21.5 ±46.3),(35.5±45.8)比(-59.5 ±64.5),P＜0.05.SVRI,SSVRI,PP/SVI及EaI均與24、72 rLac及7 rLac相關,P＜0.01.結論 感染性休剋患者血管痳痺時,SVRI,SSVRI,PP/SVI及EaI與預後及組織灌註相關,其中SSVRI,PP/SVI及EaI相關性更彊.
목적 탐토감염성휴극환자혈관마비대예후급조직관주적영향.방법 회고분석2010년1월지2011년7월북경협화의원중증의학과련속수치적감염성휴극환자73례.근거28 d생존상황분존활조화사망조,기록초시혈류동역학삼수、동맥혈유산、APACHEⅡ평분급28 d생존상황.결과 사망조초시급성생이학여만성건강(APACHE)Ⅱ평분고우존활조,(14.6±5.6)분비(20.4±4.8)분,P＜0.01；매박외주혈관조력지수(SSVRI) (212.7 ±52.6)비(185.4 ±50.5)、맥압매박지수비치(PP/SVI) (2.8 ±0.7)비(2.5±0.6),유효주동맥탄성지수(EaI)(5.0±1.2)비(4.3±1.1),24、72 h유산청제솔(rLac)이급7 rLac균현저저우존활조,(18.4±46.4)비(21.5 ±49.7),(19.9±49.6)비(-21.5 ±46.3),(35.5±45.8)비(-59.5 ±64.5),P＜0.05.SVRI,SSVRI,PP/SVI급EaI균여24、72 rLac급7 rLac상관,P＜0.01.결론 감염성휴극환자혈관마비시,SVRI,SSVRI,PP/SVI급EaI여예후급조직관주상관,기중SSVRI,PP/SVI급EaI상관성경강.
Objective To explore the effects of vascular paralysis upon prognosis and tissue perfusion in septic shock patients.Methods A total of 73 septic shock patients consecutively admitted into our department from January 2010 to July 2011 were retrospectively studied.Their hemodynamic data,arterial lactate concentration and APACHE Ⅱ (acute physiology and chronic health evaluation Ⅱ) score at the beginning of cardiac output monitoring (0 h),as well as the outcome of Day 28 post-diagnosis were recorded.Stroke volume index (SVI) and cardiac index (CI) were obtained through transpulmonary thermodilution technique by pulse induced continuous cardiac output (PiCCO) system.Results (1)APACHE Ⅱ score at 0 h was higher in non-survivors than those in survivors ((14.6 ± 5.6) vs (20.4 ±4.8),P ＜0.01).Stroke systemic vascular resistance index (SSVRI),pulse pressure/stroke volume index (PP/SVI),effective arterial elastance index (EaI),24 h lactate clearance rate (24 rLac),72 h lactate clearance rate (72 rLac)and 7 d lactate clearance rate (7 rLac)in non-survivors were all lower than those in survivors (P ＜ 0.05) ; (2) SVRI,SSVRI,PP/SVI and EaI were all correlated significantly with 24 rLac,72 rLac and 7 rLac [(212.7 ± 52.6) vs (185.4 ± 50.5),PP/SVI:(2.8 ± 0.7) vs (2.5 ± 0.6),EaI:(5.0 ±1.2) vs (4.3 ±1.1),24/72/7 rLac:(18.4 ±46.4) vs (21.5 ±49.7),(19.9 ±49.6) vs (-21.5 ± 46.3),(35.5 ± 45.8) vs (-59.5 ± 64.5),P ＜ 0.00].Conclusion Vascular paralysis is correlated with prognosis and tissue perfusion in septic shock patients.And SSVRI,PP/SVI and EaI are more significant.
