脓毒症患者心功能动态变化及其对预后的影响

Changes of Cardiac Function on Patients with Sepsis and Their Influence on Prognosis

目的:探讨脓毒症患者心功能的动态变化及该变化对预后的影响。方法:入选患者置入PiCCO导管,持续监测血流动力学指标,包括平均动脉压(MAP),心指数(CI),肺血管外水指数(ELWI),左室最大收缩力(dPmax)及全身血管阻力指数(SVRI)。于入院即刻与第7天行心脏彩色多普勒超声检查,测量左心室射血分数(LVEF),二尖瓣舒张早期充盈峰速度E峰和舒张晚期充盈峰速度A峰比值,二尖瓣环舒张早期速度(E’),并计算E/E’比值。根据预后将患者分为生存组与死亡组。结果:所有入选患者血流动力学参数表现为CI增高而SVRI显著降低。生存组MAP,CI,ELWI及SVRI在治疗后均趋于正常,与入院第1天相比有统计学意义(P<0.05);而死亡组以上参数趋于恶化,与生存组相比亦有统计学意义(P<0.05)。生存组反应心脏舒张功能的E/E’在整个研究观察过程中均较正常(E/E’<8)有所升高。死亡组无论是反应左室收缩功能的LVEF,还是E/E’均有恶化趋势,与入院即刻和生存组相比均出现统计学意义(P<0.05)。结论:在脓毒症患者中,心脏舒张功能的受损更易发生,且其发生时间远早于收缩功能受损发生的时间,其恢复也较收缩功能不全更慢。

Objective ： To investigate the changes of cardiac function in patients with sepsis and their influence on prognosis. Methods ： All enrolled patients were inserted PiCCO catheters and mortered hemodynamics by PiCCO monitor. Mean artery pressure （MAP） , car- diac index （CI） , extravascular lung water index （ ELWI）, dPmax and systemic vascular resistance index （SVRI） were recorded. Echo- cardiography was done when a patient was enrolled and on the 7th day ＇after admitted. Left ventricular eject fraction （L^VEF） , E and A peak of mitral blood velocity, mitral annulus moving speed （E＇）, E/A and E/E＇ were calculated. All patients were divided into t the surviving group and the death group according to the prognosis. Results：The CI of all enrolled patients increased and SVRI decreased significantly. MAP, CI, ELWI and SVRI in the surviving group approached to normal gradually, significant differences of time effect were found （ P 〈 0. 05 ）. The trend in the death group was on the contrary, significant differences were found between the two groups （ P 〈 0. 05）. E/E＇ in the surviving group was higher than normal （ E/E＇ 〈 8） in the whole protocol. Whereas in the death group, LVEF and E/E＇ were worsen gradually, significant differences between the two groups were found too （ P 〈 0. 05 ） Conclusion ： The occur- rence of diastolic cardiac dysfunction in sepsis patients is more common than that of systolic cardiac dysfunction. It can be found earlier than systolic cardiac dysfunction. The restoration of diastolic cardiac dysfunction is slower than that of systolic cardiac dysfunction.