静动脉血二氧化碳分压差对心肌梗死射血分数的预测价值

Predictive value of Pcv-aCO_(2)on left ventricular ejection fraction in myocardial infarction

目的观察急性心肌梗死的中心静脉-动脉血二氧化碳分压差(central venous-arterial blood carbon dioxide partial pressure difference,Pcv-aCO_(2))与左心室射血分数(left ventricle ejection fraction,LVEF)的关系。方法回顾性分析2019年11月至2021年10月福建省立医院重症监护病房收治的急性心肌梗死患者的临床资料。经床旁超声心动图测量LVEF。按LVEF将上述患者分为LVEF正常组(LVEF≥52%)和LVEF下降组(LVEF<52%)。比较两组患者的一般资料和血流动力学指标的差异。通过Jarque-Bera检验法对上述资料进行正态性检验。对血流动力学指标与LVEF进行相关性分析。采用二元Logistic回归分析LVEF下降的危险因素。采用受试者工作特征(ROC)曲线评估应用Pcv-aCO_(2)诊断LVEF下降的可行性。结果纳入72例急性心肌梗死患者进行分析,LVEF正常组25例,LVEF下降组47例。LVEF下降组的Pcv-aCO_(2)高于LVEF正常组[(7.13±1.19)mmHg vs.(5.41±1.23)mmHg,P<0.01]。LVEF和Pcv-aCO_(2)呈负相关关系(rs=-0.740,P<0.01);Pcv-aCO_(2)的ROC曲线下面积为0.849(95%CI:0.758~0.939,P<0.01)。二元Logistic回归分析显示Pcv-aCO_(2)是LVEF下降的独立危险因素(OR=2.251,95%CI:1.326~3.820)。结论Pcv-aCO_(2)增大在一定程度上能够预测急性心肌梗死的LVEF下降。

Objective To investigate the relationship between central venous-arterial blood carbon dioxide partial pressure difference(Pcv-aCO_(2))and left ventricular ejection fraction(LVEF)in acute myocardial infarction.Methods Clinical data of patients with acute myocardial infarction admitted to the Intensive Care Unit of Fujian Provincial Hospital from November 2019 to October 2021 were retrospectively analyzed.LVEF was measured by bedside echocardiogram.The patients were divided into the normal LVEF group(LVEF≥52%)and decreased LVEF group(LVEF<52%)according to LVEF.The differences in general information and hemodynamic parameters between the two groups were compared.The normality of the above data was tested by the Jarque-Bera test.Correlation analysis of hemodynamic indices with LVEF was performed.Binary logistic regression was used to analyze the risk factors associated with the decrease in LVEF.The feasibility of diagnosing LVEF decline with Pcv-aCO_(2)was assessed using receiver operating characteristic(ROC)curve.Results Seventy-two patients with acute myocardial infarction were included for analysis,including 25 patients in the normal LVEF group and 47 patients in the decreased LVEF group.Pcv-aCO_(2)was significantly higher in the decreased LVEF group than that in the normal LVEF group[(7.13±1.19)mmHg vs.(5.41±1.23)mmHg,P<0.01].There was a negative correlation between LVEF and Pcv-aCO_(2)(rs=-0.740,P<0.01).The area under the ROC curve for Pcv-aCO_(2)was 0.849(95%CI:0.758-0.939,P<0.01).The binary logistic regression analysis showed that Pcv-aCO_(2)was an independent risk factor for decreased LVEF(OR=2.251,95%CI:1.326-3.820).Conclusions To a certain extent,the increase of Pcv-aCO_(2)can predict the decrease of LVEF in acute myocardial infarction.