摘要
目的探讨床旁超声测量二尖瓣舒张早期血流峰速度与二尖瓣环舒张早期运动速度比值(E/E’)与严重脓毒症(包括脓毒性休克)患者肺水肿发生的相关性。方法对2014年11月至2015年8月四川大学华西医院重症医学科重症超声数据库中诊断为严重脓毒症并符合研究纳入标准的患者进行资料分析。以肺部超声水肿评分定量肺水肿程度,以壁侧E/E’是否〉8分为两组,校正基线后比较整体肺水肿程度差异及肺水肿分布差异;分析急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、收缩功能指标〔射血分数(EF)、二尖瓣环收缩峰速度(Sd)〕、舒张功能指标(E/E’)及容量指标〔剑下长轴下腔静脉直径(IVCd)〕与肺水肿的相关性,并将差异有统计学意义的指标进行多元线性回归分析,检验E/E’是否为肺水肿的危险因素。结果纳入患者82例,E/E’低组与E/E’高组的性别、APACHEⅡ评分、原发病构成、收缩功能及容量状态等基线资料差异无统计学意义。以年龄校正基线一致,发现E/E’高组肺水肿评分高于E/E’低组(P=0.007);两组患者双肺5~6区肺水肿程度无明显差异,E/E’高组双肺1~4区水肿程度高于E/E’低组(P=0.004);E/E’和IVCd是肺水肿发生的独立危险因素(标准化回归系数分别为0.425和0.249,P均〈0.05)。结论床旁超声测量的E/E’是严重脓毒症及脓毒性休克患者肺水肿发生的独立危险因素,随着其升高肺水肿程度明显加重。
Objective To determine the association between the value of early diastolic transmitral velocity to early mitral anulus diastolic velocity ratio(E/E')measured by bedside ultrasound and pulmonary edema in severe sepsis(including septic shock)patients.Methods Data were obtained from the critical ultrasound database between November 2014 and August 2015.The severe sepsis(including septic shock)patients were eligible,but those with chronic heart disease or acute heart failure were excluded.Pulmonary edema was quantified by lung ultrasound score.The patients were divided into two groups according to lateral E/E'.E/E'-high group was defined as the lateral E/E'8,and the others were in E/E'-low group.The severity and distribution of pulmonary edema were compared between the two groups.The correlation analysis and logistic regression analysis were performed to determine whether E/E'was the independent risk factor of pulmonary edma.Results There were 82 cases included.The lung ultrasound score of E/E'-high group was significantly higher than that of E/E'-low group(P=0.007).There was no statistic difference of pulmonary edema severity in the bilateral 5th and 6th ultrasound exam areas,but E/E'-high group were more severe in the bilateral 1th to 4th ultrasound exam areas(P=0.004).Linearregression analysis demonstrated that E/E'and inferior vena cava diameter were independent risk factors of pulmonary edema(standardized regression coefficients were 0.425 and 0.249,respectively,P〈0.05).ConclusionE/E'is the independent risk factor of pulmonary edema in severe sepsis and septic shock patients.
出处
《四川大学学报(医学版)》
CAS
CSCD
北大核心
2016年第4期580-583,共4页
Journal of Sichuan University(Medical Sciences)
关键词
床旁超声
二尖瓣
多普勒
E/E’
肺水肿
脓毒症
Bedside ultrasound
Valvulabicuspidalis
Doppler
E/E’
Pulmonary edema Sepsis