中华内科杂志
中華內科雜誌
중화내과잡지
Chinese Journal of Internal Medicine
2015年
10期
855-859
,共5页
崔克亮%王小亭%张宏民%柴文昭%刘大为
崔剋亮%王小亭%張宏民%柴文昭%劉大為
최극량%왕소정%장굉민%시문소%류대위
休克,脓毒性%左心功能不全%中心静脉压%Logistic模型
休剋,膿毒性%左心功能不全%中心靜脈壓%Logistic模型
휴극,농독성%좌심공능불전%중심정맥압%Logistic모형
Shock,septic%Left ventricular dysfunction%Central venous pressure%Logistic models
目的 探讨中心静脉压(CVP)、中心静脉血氧饱和度(ScvO2)、静-动脉血二氧化碳分压差(Pv-aCO2)联合诊断感染性休克相关左心功能不全的价值.方法 选2013年9月至2014年9月北京协和医院重症医学科诊治的感染性休克患者93例,记录CVP、ScvO2、Pv-aCO2.以超声心动图检测左室射血分数＜50％为标准,将患者分为新发左心功能不全组和未发左心功能不全组.使用logistic回归建立诊断模型,通过ROC曲线评价各指标单独及联合诊断的价值.结果 93例感染性休克患者中,39例发生左心功能不全.新发左心功能不全组CVP[(12.5±3.9)mmHg(1 mmHg=0.133 kPa)比(10.4±2.5)mmHg,P=0.005]、Pv-aCO2[(7.5±3.9) mmHg比(4.5±2.6) mmHg,P ＜0.001]显著高于未发左心功能不全组,ScvO2显著低于未发左心功能不全组[(62.4±10.5)％比(72.6±9.0)％,P＜0.001],差异有统计学意义.采用CVP、Pv-aCO2、ScvO2诊断新发左心功能不全时,CVP≥12.5 mmHg敏感度为46.2％,特异度为81.5％,AUCROC为0.674;Pv-aCO2 ≥5.0 mmHg敏感度为76.9％,特异度为37.0％,AUCRoC为0.738;ScvO2≤65.8％敏感度为64.1％,特异度为78.6％,AUCROC为0.775.以logistic回归预测概率作为诊断指标、根据ROC曲线确定界值,诊断模型≥0.377,敏感度为82.1％,特异度为79.6％,AUCROC为0.835.结论 对感染性休克患者是否发生左心功能不仝,通过Pv-aCO2、ScvO2、CVP建立logistic回归模型,利用预测概率进行辅助诊断具有一定价值.
目的 探討中心靜脈壓(CVP)、中心靜脈血氧飽和度(ScvO2)、靜-動脈血二氧化碳分壓差(Pv-aCO2)聯閤診斷感染性休剋相關左心功能不全的價值.方法 選2013年9月至2014年9月北京協和醫院重癥醫學科診治的感染性休剋患者93例,記錄CVP、ScvO2、Pv-aCO2.以超聲心動圖檢測左室射血分數＜50％為標準,將患者分為新髮左心功能不全組和未髮左心功能不全組.使用logistic迴歸建立診斷模型,通過ROC麯線評價各指標單獨及聯閤診斷的價值.結果 93例感染性休剋患者中,39例髮生左心功能不全.新髮左心功能不全組CVP[(12.5±3.9)mmHg(1 mmHg=0.133 kPa)比(10.4±2.5)mmHg,P=0.005]、Pv-aCO2[(7.5±3.9) mmHg比(4.5±2.6) mmHg,P ＜0.001]顯著高于未髮左心功能不全組,ScvO2顯著低于未髮左心功能不全組[(62.4±10.5)％比(72.6±9.0)％,P＜0.001],差異有統計學意義.採用CVP、Pv-aCO2、ScvO2診斷新髮左心功能不全時,CVP≥12.5 mmHg敏感度為46.2％,特異度為81.5％,AUCROC為0.674;Pv-aCO2 ≥5.0 mmHg敏感度為76.9％,特異度為37.0％,AUCRoC為0.738;ScvO2≤65.8％敏感度為64.1％,特異度為78.6％,AUCROC為0.775.以logistic迴歸預測概率作為診斷指標、根據ROC麯線確定界值,診斷模型≥0.377,敏感度為82.1％,特異度為79.6％,AUCROC為0.835.結論 對感染性休剋患者是否髮生左心功能不仝,通過Pv-aCO2、ScvO2、CVP建立logistic迴歸模型,利用預測概率進行輔助診斷具有一定價值.
목적 탐토중심정맥압(CVP)、중심정맥혈양포화도(ScvO2)、정-동맥혈이양화탄분압차(Pv-aCO2)연합진단감염성휴극상관좌심공능불전적개치.방법 선2013년9월지2014년9월북경협화의원중증의학과진치적감염성휴극환자93례,기록CVP、ScvO2、Pv-aCO2.이초성심동도검측좌실사혈분수＜50％위표준,장환자분위신발좌심공능불전조화미발좌심공능불전조.사용logistic회귀건립진단모형,통과ROC곡선평개각지표단독급연합진단적개치.결과 93례감염성휴극환자중,39례발생좌심공능불전.신발좌심공능불전조CVP[(12.5±3.9)mmHg(1 mmHg=0.133 kPa)비(10.4±2.5)mmHg,P=0.005]、Pv-aCO2[(7.5±3.9) mmHg비(4.5±2.6) mmHg,P ＜0.001]현저고우미발좌심공능불전조,ScvO2현저저우미발좌심공능불전조[(62.4±10.5)％비(72.6±9.0)％,P＜0.001],차이유통계학의의.채용CVP、Pv-aCO2、ScvO2진단신발좌심공능불전시,CVP≥12.5 mmHg민감도위46.2％,특이도위81.5％,AUCROC위0.674;Pv-aCO2 ≥5.0 mmHg민감도위76.9％,특이도위37.0％,AUCRoC위0.738;ScvO2≤65.8％민감도위64.1％,특이도위78.6％,AUCROC위0.775.이logistic회귀예측개솔작위진단지표、근거ROC곡선학정계치,진단모형≥0.377,민감도위82.1％,특이도위79.6％,AUCROC위0.835.결론 대감염성휴극환자시부발생좌심공능불동,통과Pv-aCO2、ScvO2、CVP건립logistic회귀모형,이용예측개솔진행보조진단구유일정개치.
Objective To evaluate the value of central venous pressure (CVP),central venous oxygen saturation (ScvO2) and venous-arterial carbon dioxide partial pressure gradient (Pv-aCO2) in the diagnosis of septic shock-induced left ventricular dysfunction.Methods Consecutive patients with septic shock were enrolled from September 2013 to September 2014 in ICU at Peking Union Medical College Hospital.The data of CVP,Pv-aCO2 and ScvO2 were recorded and analyzed.According to the left ventricular ejection fraction (LVEF) tested by bedside echocardiography,the patients were divided into two groups:new onset of left ventricular dysfunction (LVEF ＜ 50％) group and non-left ventricular dysfunction (LVEF ≥ 50％) group.A diagnostic model was created by logistic regression.The diagnostic performance and cut-off values of CVP,Pv-aCO2,ScvO2 were determined using receiver operating characteristic (ROC) curve analysis.Results Among 93 patients enrolled,39 were diagnosed with left ventricular dysfunction.In the new onset group,CVP [(12.5±3.9) mmHg(1 mmHg=0.133 kPa) vs (10.4±2.5)mmHg;P=0.005] and Pv-aCO2 [(7.5 ± 3.9) mmHg vs (4.5 ± 2.6) mmHg;P ＜ 0.001] were significantly higher than those in the non-left ventricular dysfunction group,while ScvO2 [(62.4 ± 10.5) ％ vs (72.6 ± 9.0) ％;P ＜ 0.001] was significantly lower.As far as the diagnostic value of these three parameters were concerned for left ventricular dysfunction,the sensitivity of CVP ≥ 12.5 mmHg was 46.2％,specificity 81.5％ with an area under ROC curve (AUCROC) 0.674;the sensitivity of Pv-aCO2 ≥ 5.0 mmHg 76.9％,specificity 37.0％,AUCROC 0.738;the sensitivity of ScvO2 ≤65.8％ 64.1％,specificity 78.6％,AUCROC 0.775.When the cut-off values were determined by ROC,the diagnostic performance of the model was ≥0.377 with the sensitivity,specificity and AUCROC 82.1％,79.6％ and 0.835,respectively.Conclusion In patients with septic shock,the logistic regression model established by CVP,Pv-aCO2 and ScvO2 contributes to the diagnosis of septic shock-induced left ventricular dysfunction.
