血管外肺水指数与心指数对心源性休克患者预后的预测价值

The Predictive Value of Extra Vascular Lung Water Index and Cardiac Index on Cardiac Shock Prognosis

目的：探讨脉搏分析连续心排量（PiCCO）监测相关血流动力学参数对心源性休克患者预后的预测价值。方法：前瞻性选择2012—01至2013—05重症监护病房收治的心源性休克患者54例，采集患者一般资料、行PiCCO血流动力学监测，记录患者治疗前和治疗48h后的心指数（CI）、血管外肺水指数（EVWI）、全心射血分数（GEF）、全心舒张末期容积指数（GEDI）、全身血管阻力指数（SVRI）等参数。并根据患者28d存滑隋况，分别纳入存活组（n=28）和死亡组（n=26），比较两组的参数，并绘制患者工作特征曲线（ROC曲线），分析其对预后结局的预测价值。结果：治疗前、治疗48h后，存活组与死亡组比较，心指数、全心射血分数均明显升高，而EVWI、SVRI均明显降低，差异均有统计学意义（P〈0．05～0．01）；而全心舒张末期容积指数两组变化差异无统计学意义（P〉0．05）。治疗48h后，EvwI的ROC曲线下面积为AUCEVWI=0．846，切点值为7．5ml／kg；心指数的ROC曲线下面积AUCCr=0．884、切点值为3．46L／（min·m^2），全心射血分数的ROC曲线下面积为AUCGEF=0．853、切点值为16．5％。三个参数的敏感性和特异性均较高（分别为79．2％，81．0％；82．8％，83．0％；74．1％，88．7％）。多因素Logistic回归分析心指数和EVWI是影响心源性休克患者预后的独立预测因素。结论：动态监测PiCCO的血流动力学参数对心源性休克患者的液体管理的剂量平衡窗有指导意义，而治疗48h后的心指数和EVWI对心源性休克患者的预后有独立的预测价值。

Objective： To explore the predictive value of relevant hemodynemics indexes on cardiac shock prognosis by PiCCO technology. Methods： A total of 54 consecutive patients with cardiac shock treated in our hospital from 2012-01 to 2013-05 were studied. The patients＇ general information with hempdynemics indexes as cardiac index （CI）, extra vascular lung water index （EVWI）, general ejection fraction （GEF）, general end diastolic index （GEDI）, systolic vascular resistance index （SVRI） were monitored by PiCCO technology at before and 48 hours after treatment. Based on 28 days surviving condition, the patients were divided into 2 groups： Survival group, n=28 and Death group, n=26. The levels of above indexes were compared between 2 groups and their predictive values on cardiac shock prognosis were calculated by ROC curve analysis. Results： Compared with Death group, Survival group presented much higher CI, GEF and much lower EVWI, SVRI at before and 48 hours after treatment, P〈0.05-0.01, while GEDI was similar between 2 groups, P〉0.05. With 48 hours treatment, the ROC analysis showed AUCEVWI = 0.846 with cut-off point at 7.5ml/kg, AUCCI= 0.884 with cut-off point at 3.46 L/（min· m^2） and AUC6EF = 0.853 with cut-off point at 16.5%; the sensitivity and specificity of EVWI, CI, GEF were 79.2% and 81.0%, 82.8% and 83.0%, 74.1% and 88.7% respectively. Multivariate Logistic regression analysis indicated that CI and EVWI were the independent predictors for cardiac shock prognosis. Conclusion： PiCCO monitoring technology may guide the balance of relevant hempdynemics indexes in patients with cardiac shock. With 48 hours treatment, the levels of CI and EVWI had predictive value for cardiac shock prognosis.