中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
1期
43-47
,共5页
陈炜%臧学峰%牛素平%吕超%赵磊%盛博%古旭云%张静姝
陳煒%臧學峰%牛素平%呂超%趙磊%盛博%古旭雲%張靜姝
진위%장학봉%우소평%려초%조뢰%성박%고욱운%장정주
脓毒性休克%血管外肺水指数%肺毛细血管通透性指数%平均动脉压%预后
膿毒性休剋%血管外肺水指數%肺毛細血管通透性指數%平均動脈壓%預後
농독성휴극%혈관외폐수지수%폐모세혈관통투성지수%평균동맥압%예후
Septic shock%Extravascular lung water index%Pulmonary vascular permeability index%Mean arterial pressure%Prognosis
目的 观察脓毒性休克患者液体复苏前后血流动力学参数对其短期预后的影响.方法 回顾性分析2013年1月至2014年10月入住北京世纪坛医院重症医学科76例脓毒性休克并行液体复苏患者的临床资料,所有患者入科后立即用脉搏指示连续心排血量仪(PiCCO)监测血流动力学参数,记录液体复苏前及复苏后6h的平均动脉压(MAP)、每搏量指数(SVI)、心排血指数(CI)、全心射血分数(GEF)、全心舒张期末容积指数(GEDVI)、胸腔内血容量指数(ITBVI)、血管外肺水指数(EVLWI)、外周血管阻力指数(SVRI)、肺毛细血管通透性指数(PVPI)等.根据7d预后将患者分为生存组(42例)和死亡组(34例).比较两组血流动力学参数的差异,并绘制受试者工作特征曲线(ROC),分析复苏前及复苏后6h各参数对患者早期预后的预测价值.采用多因素logistic回归分析脓毒性休克患者7d预后的预测因素.结果 ①与液体复苏前比较,存活组复苏后6h的EVLWI、PVPI均明显下降[EVLWI (mL/kg):7.33±1.72比9.07±2.81,PVPI:1.39±0.34比1.74±0.50,均P＜0.01];死亡组复苏后6h的EVLWI、PVPI均明显升高[EVLWI(mL/kg):12.62±3.58比8.97±2.74,PVPI:2.36±0.81比1.73±0.60,均P＜0.01],而MAP进一步下降[MAP (mmHg,1 mmHg=0.133 kPa):70.53±12.12比77.06±13.48,P＜0.01].②ROC曲线显示,液体复苏后6 h EVLWI的ROC曲线下面积(AUC)为0.914,临界值为9.50 mL/kg时的敏感度为82.4％,特异度为88.1％;PVPI的AUC为0.890,临界值为1.75时的敏感度为73.5％,特异度为92.9％.③多因素logistic回归分析显示,液体复苏后6h的EVLWI是脓毒性休克患者7d预后的独立预测因素[优势比(OR)=0.546,95％可信区间(95％CI)=0.852 ～ 0.976,P=0.006].结论 PiCCO监测的血流动力学参数EVLWI、PVPI、MAP与脓毒性休克患者的预后相关,液体复苏后6h的EVLWI是评估脓毒性休克患者短期预后的早期独立预测因素.
目的 觀察膿毒性休剋患者液體複囌前後血流動力學參數對其短期預後的影響.方法 迴顧性分析2013年1月至2014年10月入住北京世紀罈醫院重癥醫學科76例膿毒性休剋併行液體複囌患者的臨床資料,所有患者入科後立即用脈搏指示連續心排血量儀(PiCCO)鑑測血流動力學參數,記錄液體複囌前及複囌後6h的平均動脈壓(MAP)、每搏量指數(SVI)、心排血指數(CI)、全心射血分數(GEF)、全心舒張期末容積指數(GEDVI)、胸腔內血容量指數(ITBVI)、血管外肺水指數(EVLWI)、外週血管阻力指數(SVRI)、肺毛細血管通透性指數(PVPI)等.根據7d預後將患者分為生存組(42例)和死亡組(34例).比較兩組血流動力學參數的差異,併繪製受試者工作特徵麯線(ROC),分析複囌前及複囌後6h各參數對患者早期預後的預測價值.採用多因素logistic迴歸分析膿毒性休剋患者7d預後的預測因素.結果 ①與液體複囌前比較,存活組複囌後6h的EVLWI、PVPI均明顯下降[EVLWI (mL/kg):7.33±1.72比9.07±2.81,PVPI:1.39±0.34比1.74±0.50,均P＜0.01];死亡組複囌後6h的EVLWI、PVPI均明顯升高[EVLWI(mL/kg):12.62±3.58比8.97±2.74,PVPI:2.36±0.81比1.73±0.60,均P＜0.01],而MAP進一步下降[MAP (mmHg,1 mmHg=0.133 kPa):70.53±12.12比77.06±13.48,P＜0.01].②ROC麯線顯示,液體複囌後6 h EVLWI的ROC麯線下麵積(AUC)為0.914,臨界值為9.50 mL/kg時的敏感度為82.4％,特異度為88.1％;PVPI的AUC為0.890,臨界值為1.75時的敏感度為73.5％,特異度為92.9％.③多因素logistic迴歸分析顯示,液體複囌後6h的EVLWI是膿毒性休剋患者7d預後的獨立預測因素[優勢比(OR)=0.546,95％可信區間(95％CI)=0.852 ～ 0.976,P=0.006].結論 PiCCO鑑測的血流動力學參數EVLWI、PVPI、MAP與膿毒性休剋患者的預後相關,液體複囌後6h的EVLWI是評估膿毒性休剋患者短期預後的早期獨立預測因素.
목적 관찰농독성휴극환자액체복소전후혈류동역학삼수대기단기예후적영향.방법 회고성분석2013년1월지2014년10월입주북경세기단의원중증의학과76례농독성휴극병행액체복소환자적림상자료,소유환자입과후립즉용맥박지시련속심배혈량의(PiCCO)감측혈류동역학삼수,기록액체복소전급복소후6h적평균동맥압(MAP)、매박량지수(SVI)、심배혈지수(CI)、전심사혈분수(GEF)、전심서장기말용적지수(GEDVI)、흉강내혈용량지수(ITBVI)、혈관외폐수지수(EVLWI)、외주혈관조력지수(SVRI)、폐모세혈관통투성지수(PVPI)등.근거7d예후장환자분위생존조(42례)화사망조(34례).비교량조혈류동역학삼수적차이,병회제수시자공작특정곡선(ROC),분석복소전급복소후6h각삼수대환자조기예후적예측개치.채용다인소logistic회귀분석농독성휴극환자7d예후적예측인소.결과 ①여액체복소전비교,존활조복소후6h적EVLWI、PVPI균명현하강[EVLWI (mL/kg):7.33±1.72비9.07±2.81,PVPI:1.39±0.34비1.74±0.50,균P＜0.01];사망조복소후6h적EVLWI、PVPI균명현승고[EVLWI(mL/kg):12.62±3.58비8.97±2.74,PVPI:2.36±0.81비1.73±0.60,균P＜0.01],이MAP진일보하강[MAP (mmHg,1 mmHg=0.133 kPa):70.53±12.12비77.06±13.48,P＜0.01].②ROC곡선현시,액체복소후6 h EVLWI적ROC곡선하면적(AUC)위0.914,림계치위9.50 mL/kg시적민감도위82.4％,특이도위88.1％;PVPI적AUC위0.890,림계치위1.75시적민감도위73.5％,특이도위92.9％.③다인소logistic회귀분석현시,액체복소후6h적EVLWI시농독성휴극환자7d예후적독립예측인소[우세비(OR)=0.546,95％가신구간(95％CI)=0.852 ～ 0.976,P=0.006].결론 PiCCO감측적혈류동역학삼수EVLWI、PVPI、MAP여농독성휴극환자적예후상관,액체복소후6h적EVLWI시평고농독성휴극환자단기예후적조기독립예측인소.
Objective To investigate the short term predictive value of hemodynamic parameters during fluid resuscitation in patients with septic shock.Methods Data of 76 patients with septic shock admitted to Department of Critical Care Medicine of Beijing Shijitan Hospital from January 2013 to October 2014 were retrospectively analyzed.The hemodynamic parameters were monitored by pulse indicator continuous cardiac output (PiCCO),including mean arterial pressure (MAP),stroke volume index (SVI),cardiac index (CI),global ejection fraction (GEF),global end diastolic volume index (GEDVI),intrathoracic blood volume index (ITBVI),extravascular lung water index (EVLWI),systemic vascular resistance index (SVRI),and pulmonary vascular permeability index (PVPI).They were recorded before and 6 hours after fluid resuscitation.According to the prognosis on the 7th day,the patients were divided into survival group (n =42) and death group (n =34).The PiCCO records between two groups were compared and a receiver operating characteristic (ROC) curve for predicting the outcome was plotted to find the cut-off point value for each PiCCO record before and 6 hours after fluid resuscitation.The factors for predicting 7-day prognosis of patients with septic shock were analyzed by multivariate logistic regression analysis.Results ① Compared with those before fluid resuscitation,EVLWI and PVPI were significantly decreased at 6 hours after fluid resuscitation in the survival group [EVLWI (mL/kg):7.33 ± 1.72 vs.9.07 ± 2.81,PVPI:1.39 ± 0.34 vs.1.74 ±0.50,both P＜0.01] but they were significantly increased in the death group [EVLWI (mL/kg):12.62± 3.58 vs.8.97 ± 2.74,PVPI:2.36± 0.81 vs.1.73 ± 0.60,both P＜0.01],and MAP in the death group decreased after fluid resuscitation [MAP (mmHg,1 mmHg =0.133 kPa):70.53 ± 12.12 vs.77.06±13.48,P＜0.01].②ROC curve showed that the area under ROC curve (AUC) of EVLWI at 6 hours after fluid resuscitation was 0.914,cut-off value was 9.50 mL/kg,the sensitivity was 82.4％ and the specificity was 88.1％.The AUC of PVPI was 0.890,when cut-off value was 1.75,the sensitivity was 73.5％,and the specificity was 92.9％.③ It was shown by multivariate logistic regression analysis that only EVLWI at 6 hours after fluid resuscitation was an independent predictor for 7-day prognosis of septic patient [odds ratio (OR) =0.546,95％ confidence interval (95％CI) =0.852-0.976,P =0.006].Conclusion PiCCO monitoring indicators such as EVLWI,PVPI and MAP have certain prognostic value for septic patients,but only EVLWI at 6 hours after fluid resuscitation is an independent prognostic factor for short term prognosis.
