感染性休克患者超声心动图检查右心室功能的诊断价值

Diagnostic value of echocardiography in examination of right ventricle function of patients with septic shock

目的探讨感染性休克患者超声心动图检查右心室功能的临床诊断价值,为诊断感染性休克患者出现右心室功能不全提供依据。方法选取2010年3月-2013年5月就诊的感染性休克患者50例设为观察组,同期选取50名健康体检人员设为对照组,使用超声心动图、右心功能监护仪以及心电监护仪监测两组右心室功能变化,并进行分析比较,采用SPSS 14.0软件行数据统计分析,计数资料采用χ2检验。结果观察组患者三尖瓣口充盈早期最大流速减速时间(Dte)、充盈早期最大流速(E)、充盈晚期最大流速(A)、右心室射血分数(RVEF)、右心室每搏作功指数(RVSWI)、右心室作功指数(RCWI)在休克早期分别为:(145.25±16.31)s、(0.47±0.12)m/s、(0.63±0.12)m/s、(0.37±0.09)%、(1.66±0.47)g/(mlom2)、(32.89±7.59)g/m2,休克晚期上述指标分别为:(130.26±20.13)s、(0.41±0.15)m/s、(0.69±0.14)m/s、(0.34±0.08)%、(1.43±0.50)g/(mlom2)、(28.23±5.49)g/m2,与对照组比较呈持续性下降(P<0.05),而右心室室壁应力(RVWS)在休克早、晚期分别为(33.45±6.73)、(37.22±6.78)dyn/cm2,呈上升趋势;休克纠正后RVEF、RVWS逐渐恢复,而Dte、E/A、RVSWI、RCWI未见显著好转。结论感染性休克患者超声心动图在早期即可监测到右心室功能的改变,在晚期同样具有重要的右心室功能不全诊断意义,值得临床推广使用。

OBJECTIVE To explore the diagnostic value of echocardiography in examination of right ventricle function of patients with septic shock so as to provide evidence for the dysfunction of right ventricle of the patients with septic shock. METHODS Totally 50 cases of septic shock who were treated in the hospital from Mar 2010 to May 2013 were chosen as the observation group, meanwhile 50 health people undergoing physical examination were set as the control group, then the change of function of right ventricle was monitored by using the eehocardiography, right ventricular function monitor, and ECG, the statistical analysis was performed with the use of SPSS14.0 software, and the chi-square test was conducted for count data. RESULTS The early filling deceleration time of tricuspid maximum velocity of the observation group was （145.25 ±16.31）s at the early stage of septic shock, （130. 26±20.13） s at late stage of septic shock, the peak of early inflow velocity （E） was （0. 47±0. 12）m/s at the early stage of septic shock, （0.41±0.15）m/s at the late stage of septic shock; the peak of late inflow velocity （A） was （0. 63±0.12）m/s at the early stage of septic shock, （0. 69±0.14） m/s at the late stage of septic shock; the right ventrieular ejection fraction （RVEF） was （0. 37 ±0. 09）% at the early stage of septic shock, （0. 34 ±0.08）% at the late stage of septic shock; the right ventricular systolic work index （RVSWI） was （1.66±0.47） g/（mlom2） at the early stage of septic shock, （1.43±0.50） g/（mlom2） at the late stage of septic shock; the right cardiac work index （RCWI） was （32.89±7.59）g/m2 at the early stage of septic shock, （28.23±5.49） g/m2 at the late stage of septic shock, as compared with the control group, these indicators showed an continuous decrease （P〈0.05）; while the right ventricular wall stress （RVWS） was （33.45±6.73） dyn/cm2 at the early stage of septic shock, （37.22±6.78）dyn/cm2 at the late stage of septic shock, showing an upward trends the RVEF and RVWS gradually restored after the shocks were corrected, however, the Dte, E/A, RVSWI, or RCWI was not significantly improved. CONCLUSION The echocardiography can monitor the change of right ventricular function of the septic shock patients in the early stage and has the same value in diagnosis of dysfunction of right ventricle in the late stage, which is worthy to he promoted in the hospital.