脓毒性休克患者左心室-动脉耦联与容量反应性的相关性

倪逊; 唐迎迎; 吕建农

doi:10.13201/j.issn.1009-5918.2020.10.009

脓毒性休克患者左心室-动脉耦联与容量反应性的相关性

- 1. 徐州医科大学附属宿迁医院南京鼓楼医院集团宿迁市人民医院重症医学科(江苏宿迁, 223800);
- 2. 徐州医科大学附属医院急诊ICU
基金项目:
2015年宿迁市产业发展引导资金项目(No:S201517)

详细信息

通讯作者: 吕建农,E-mail:jiannong59@163.com

中图分类号: R563.1

收稿日期: 2020-08-12

Correlation between left ventricular-arterial coupling and volume responsiveness in patients with septic shock

- 1 Department of Critical Care Medicine, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, Suqian, Jiangsu, 223800, China;
- 2 Department of Emergency ICU, the Affiliated Hospital of Xuzhou Medical University

More Information

Corresponding author: LU: Jian-nong, E-mail: jiannong59@163.com

Received Date: 12 August 2020

摘要

摘要: 目的:探讨脓毒性休克患者左心室-动脉耦联(VAC)与容量反应性的相关性。方法:回顾性分析2016-05-2019-05期间我院收治的脓毒性休克患者共54例,VAC通过有效主动脉弹性指数(EaI)、左心室收缩末期弹性指数(EesI)和EaI/EesI进行评估。脓毒性休克患者在脉搏指示持续心排血量(PiCCO)监测下全心舒张末期容积指数(GEDVI)增加超过10%为液体复苏成功,根据心脏指数(CI)增加是否超过10%分为容量反应组(VVr)和无反应性(VVur)组。记录两组患者VAC变异,用ΔEaI/EesI表示。结果:VVr组EaI(ΔEaI)、EaI/EesI(ΔEaI/EesI)、外周血管阻力指数(ΔSVRI)的变化明显低于VVur组(P<0.05);ΔEaI/EesI ≤ 0的患者心脏指数(ΔCI)、每搏量指数(ΔSVI)和EesI(ΔEesI)的变化显著升高;ΔEaI/EesI>0的患者ΔEaI和ΔSVRI明显降低(P<0.05)。ΔCI与ΔEaI(r=-0.47,P=0.003)、ΔEaI/EesI(r=-0.68,P<0.01)和ΔSVRI(r=-0.57,P<0.01)呈负相关;ΔEaI/EesI ≤ 0组患者比ΔEaI/EesI>0组患者容量反应率更高(85.7%vs. 30.0%;P=0.015)。结论:脓毒性休克患者VAC变化与左心室容量反应性不佳有关。
- 容量反应性 /
- 复苏 /
- 脓毒性休克 /
- 心室-动脉耦联
Abstract: Objective:To investigate the relationship between left ventricular arterial coupling(VAC) and volume responsiveness in septic shock patients. Method:This is a retrospective observational study of septic shock patients(n=54) who were admitted to our hospital from May 2016 to May 2019. VAC was evaluated by effective arterial elastance(EaI), left ventricular end-systolic elasticity index(EesI), and EaI/EesI. Successfully fluid resuscitation was defined as general end-diastolic ventricular volume index(GEDVI) increase of more than 10% under the monitoring of pulse indicator continuous cardiac output(PiCCO). Septic shock patients were divided into volume responsive(VVr), and volume unresponsive(VVur) groups based on a cardiac index(CI) increase above 10%. Record VAC variation, defined as EaI/EesI variation(ΔEaI/EesI). Result:Variations of EaI(ΔEaI), EaI/EesI(ΔEaI/EesI), and systemic vascular resistance index(ΔSVRI) in the VVr group were significantly lower than those in the VVur group(P<0.05). Variations of cardiac index(ΔCI), stroke volume index(ΔSVI), and EesI(ΔEesI) were significantly higher in patients with ΔEaI/EesI ≤ 0. Concomitantly, ΔEaI and ΔSVRI were significantly diminished as compared with patients with ΔEaI/EesI>0(P<0.05). ΔCI has an inverse relationship with both DEaI(r=-0.47, P=0.003), ΔEaI/EesI(r=-0.68, P<0.01), and ΔSVRI(r=-0.57, P<0.01). We observed more patients who were fluid responsive in the ΔEaI/EesI ≤ 0 group than ΔEaI/EesI>0 group(85.7% vs. 30.0%;P=0.015).Conclusion:Variation of VAC is related to suboptimal left ventricular volume responsiveness among patients with septic shock.
- fluid responsiveness /
- resuscitation /
- septic shock /
- ventricular-arterial coupling

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