压力与容积指标在感染性休克合并心功能抑制时的临床意义

Correlation between pressure and volume parameters of septic shock patients with cardiac depression

目的对感染性休克患者进行临床研究，分析心功能抑制在感染性休克中的作用及表现。方法回顾性分析2005年1月至2009年6月收治的77例感染性休克患者的临床资料，根据早期复苏后心排血指数（CI）分组，高CI组患者39例，低CI组患者38例，比较两组治疗达标率、诊断后28d病死率以及全心舒张末容积指数（GEDI）随中心静脉压（CVP）变化情况。结果（1）高CI组患者与低CI组患者年龄、急性生理及慢性健康评分（APACHE Ⅱ）、治疗达标率及诊断后28d病死率差异有统计学意义（P〈0．05）。（2）低CI组中，有16例患者的GEDI不随CVP上升而增加，而在高CI组只有6例，差异有统计学意义（P〈0．05）。（3）低cI组中，GEDI不随CVP上升而增加的患者中心静脉血氧饱和度（ScvO2）和治疗达标率较低，动脉血乳酸和病死率较高，与GEDI随CVP上升而增加的患者比较，差异有统计学意义（P〈0．05）。结论GEDI与CVP的相关性可以作为反映感染性休克患者心功能变化的指标，尤其对于CI降低的患者，GEDI不随CVP上升而增加提示心功能抑制，且是预后不良的早期指标；高龄、APACHE Ⅱ评分高的感染性休克患者更易合并心功能抑制。

Objective To investigate the characteristics and influence of cardiac depression on patients with septic shock. Methods Seventy seven septic shock patients treated from January 2005 to June 2009 were retrospectively studied, they were divided into two groups based on cardiac index （CI） after early resuscitation, high CI group： CI≥3 L/（min.m^2） ,low CI group： CI 〈3 L/（min.m^2）. Rate of goal achievement, prognosis and whether the global end diastolic volume index （GEDI） increases with central venous pressure （CVP） growth of the two groups were compared. Results There were 38 patients in the low CI group, and 39 patients in the high CI group. Compared with patients in the high CI group, patients in the low CI group had older age and higher APACHE Ⅱ score（P 〈0. 05）. Compared with patients in the high CI group, patients in the low CI group had higher mortality rate and lower rate of goal achievement （ P 〈 0. 05 ）. In low CI group, 16 patients＇ GEDI didn＇t increase with CVP growth, and in high CI group only 6 patients＇ GEDI didn＇t increase with CVP growth （P 〈0. 05） ; In low CI group, patients whose GEDI didn＇t increase with CVP growth had higher arterial lactate, lower ScvO2, lower rate of goal achievement and worse prognosis than patients whose GEDI increased with CVP growth（ P 〈 0.05 ）. Conclusions For septic shock patients, correlation between CVP and GEDI can reflect cardiac function. Especially for patients with low CI, GEDI doesn＇t increase with CVP growth is a signal of cardiac depression and can be an early indicator of worse prognosis. Older septic shock patients and those with higher APACHE Ⅱ score tend to have the complication of cardiac depression.