糖尿病合并脓毒症休克患者脉搏指示连续心输出量监测指标的变化及其临床意义的初步探讨

Changes of pulse indicator continuous cardiac output in diabetic patients with septic shock and its clinical significance

目的观察糖尿病合并脓毒症休克患者脉搏指示连续心输出量(PiCCO)监测指标的变化,并分析其临床意义。方法选取糖尿病合并脓毒症休克患者(DM+SS组)42例和单纯脓毒症休克患者(SS组)37例,入院24h内均接受PiCCO监测。收集两组入院时的临床资料和生化指标,比较PiCCO监测相关指标的水平。采用Logistic回归分析糖尿病合并脓毒症休克的危险因素。结果入院时,DM+SS组血糖[(15.62±4.71)vs(5.47±0.27)mmol/L]、HbA1c[(7.91±2.22)%vs(5.52±0.74)%]、TG[2.00(1.37,5.44)vs 1.69(0.92,4.17)mmol/L]、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)[(28.31±5.62)vs(22.80±3.74)分]及既往病史中合并脑梗死患者比例[5(11.90%)vs 1(2.70%)]均高于SS组(P<0.05或P<0.01);DM+SS组平均动脉压(MAP)[(53.31±9.82)vs(58.44±9.50)mmHg]、中心静脉压(CVP)[(7.07±1.18)vs(8.24±2.31)mmHg]及心脏指数(CI)[(2.68±0.31)vs(3.47±0.66)L/(min·m^2)]低于SS组,胸腔内血容积指数(ITBVI)[(970.65±153.22)vs(961.44±151.58)ml/m^2]、血管外肺水指数(EVLWI)[(15.27±4.62)vs(11.11±2.16)ml/kg]、体循环阻力指数(SVRI)[(2277.76±457.18)vs(2154.48±433.27)d/(s·m2·cm5)]及肺毛细血管通透性指数(PVPI)[(3.24±1.91)vs(2.01±0.67)]高于SS组(P<0.05或P<0.01);Logistic回归分析发现,年龄、HbA1c、糖尿病合并血管并发症及继发感染是糖尿病合并脓毒症休克的危险因素(P<0.05或P<0.01)。结论糖尿病合并脓毒症休克患者较单纯脓毒症休克患者存在更为严重的血流动力学障碍。高龄、高HbA1c、糖尿病合并血管并发症及继发感染可能是糖尿病合并脓毒症休克的危险因素。

Objective To investigate the changes of pulse indicator continuous cardiac output（PiCCO）in diabetic patients with septic shock and its clinical significance. Methods A total of 79 subjects were enrolled in this study and divided into two groups：diabetic patients with septic shock（DM＋SS group,n=42）and septic shock only patients（SS group,n=37）.All the patients received the PiCCO surveillance within 24 hafter admitted to hospital.The clinical and biochemical indexes were collected and the PiCCO related indicators were compared. Results On admission,PG[（15.62±4.71）vs（5.47±0.27）mmol/L],HbA1c[（7.91±2.22）% vs（5.52±0.74）%],TG[2.00（1.37,5.44）vs 1.69（0.92,4.17）mmol/L],APACHEⅡ scores[（28.31±5.62）vs（22.80±3.74）score]and ratio of cerebralinfarction[5（11.90%）vs 1（2.70%）]were higher in DM＋SS group than in SS group（P〈0.05 or P〈0.01）.The levels of MAP[（53.31±9.82）vs（58.44±9.50）mmHg],CVP[（7.07±1.18）vs（8.24±2.31）mmHg]and CI[（2.68±0.31）vs（3.47±0.66）L/（min·m^2）]were lower,and ITBVI[（970.65±153.22）vs（961.44±151.58）ml/m^2],EVLWI[（15.27±4.62）vs（11.11±2.16）ml/kg],SVRI[（2277.76±457.18）vs（2154.48±433.27）d/（s·m2·cm5）]and PVPI[（3.24±1.91）vs（2.01±0.67）]were higher in DM＋SS group than in SS group（P〈0.05 or P〈0.01）.Logistic regression analysis showed that age,HbA1 c,diabetes with vascular complications and secondary infection were risk factors for sepsis shock in diabetic patients（P〈0.05 or P〈0.01）. Conclusion Hemodynamics disturbance is much more severe in diabetic patients with septic shock than in patients with septic shock.Elderly,high HbA1 c,diabetes with vascular complications and secondary infection may be risk factors for sepsis shock in diabetic patients.