高动力左室射血分数对早期感染性休克患者预后的影响

Effect of hyperdynamic left ventricular ejection fraction on prognosis of early septic shock patients

目的探讨高动力左室射血分数(HDLVEF)对早期感染性休克患者预后的影响。方法选取苏北人民医院收治的96例感染性休克患者为研究对象。根据28 d内是否发生死亡将患者分为死亡组(n=40)和生存组(n=56)。采用独立样本t检验或卡方检验分析2组各项临床资料是否存在差异。采用二元Logistic回归模型评估感染性休克患者发生死亡的影响因素。采用Pearson和Spearman相关性分析探讨HDLVEF与急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分的相关性。采用受试者工作特征(ROC)曲线评价各指标对感染性休克患者发生死亡的预测价值。采用Kaplan-Meier曲线对感染性休克患者进行预后生存分析。结果死亡组患者中心静脉动脉二氧化碳分压差[p_(cv-a)(CO_(2))]、APACHEⅡ评分、SOFA评分及HDLVEF高于存活组,差异有统计学意义(P<0.05)。二元Logistic回归分析显示,HDLVEF、p_(cv-a)(CO_(2))和SOFA评分是感染性休克患者发生死亡的影响因素(P<0.05)。Pearson及Spearman相关性分析显示,HDLVEF与SOFA评分、APACHEⅡ评分均呈正相关(P<0.01)。ROC曲线显示,HDLVEF预测的曲线下面积(AUC)高于p_(cv-a)(CO_(2))、SOFA评分。HDLVEF、SOFA评分联合p_(cv-a)(CO_(2))诊断的AUC高于单一指标[HDLVEF、SOFA评分或p_(cv-a)(CO_(2))],且敏感度和特异度分别为87.50%和83.93%。Kaplan-Meier曲线显示,HDLVEF高水平感染性休克患者的28 d生存率低于HDLVEF低水平患者(P<0.05)。结论HDLVEF水平是影响感染性休克患者发生死亡的重要因素,且其水平能够侧面反映患者病情,预测患者死亡情况,有望成为有效的临床指标。

Objective To investigate the effect of hyperdynamic left ventricular ejection fraction(HDLVEF)on prognosis of patients with early septic shock.Methods A total of 96 patients with septic shock admitted to Northern Jiangsu People′s Hospital were selected as study objects.Patients were divided into death group(n=40)and survival group(n=56)according to whether patients died within 28 days or not.Independent sample t test or Chi-square test were used to analyze whether there were significant differences in clinical data between the two groups.Influencing factors for occurrence of death in patients with septic shock were assessed by binary Logistic regression model.The correlations of HDLVEF with acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure estimation(SOFA)score were evaluated by Pearson and Spearman correlation analysis.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of indicators for death in patients with septic shock.Kaplan-Meier curve was used to analyze the prognostic survival of patients with septic shock.Results The differential pressure of central venous arterial carbon dioxide[p_(cv-a)(CO_(2))],APACHEⅡscore,SOFA score and HDLVEF in the death group were higher than those in the survival group(P<0.05).Binary Logistic regression analysis showed that HDLVEF,p_(cv-a)(CO_(2))and SOFA score were infuencing factors for death in septic shock patients(P<0.05).Pearson and Spearman correlation analysis showed that HDLVEF was positively correlated with SOFA score and APACHEⅡscore(P<0.05).ROC curve showed that the area under the curve(AUC)of HDLVEF was higher than that of p_(cv-a)(CO_(2))or SOFA.AUC of HDLVEF combined with SOFA score and p_(cv-a)(CO_(2))was significantly higher than those of single index[HDLVEF,SOFA score or p_(cv-a)(CO_(2))],and the sensitivity and specificity were 87.50%and83.93%,respectively.Kaplan-Meier curve showed that the 28-day survival rate in patients with septic shock was lower in high HDLVEF level patients than those with low HDLVEF level(P<0.05).Conclusion The level of HDLVEF is an important factor affecting the death of patients with septic shock,and it can reflect the patient’s condition and predict the death of patients,which is expected to become an effective clinical indicator.