心脏超声组织多普勒成像早期识别脓毒性心功能障碍的价值

Value of cardiac ultrasound tissue doppler imaging in early identification of sepsis-induced cardiac dysfunction

目的比较传统二维超声和组织多普勒成像(TDI)对早期识别脓毒性心脏功能障碍的价值。方法纳入2015年1月至2017年1月就诊于遵义医科大学附属医院重症医学科并诊断为脓毒症或脓毒性休克的患者,分为脓毒症组(n=40)和脓毒性休克组(n=30),以性别、年龄及体重指数匹配的健康人群作为对照组(n=40),并在入院24 h内同时进行床旁传统二维超声和TDI检查,并收集相关超声指标。结果3组研究对象比较发现,脓毒症组和脓毒性休克组的心率及体温均较对照组明显升高;脓毒性休克组平均动脉压(MAP)较对照组明显降低;与脓毒症组相比,脓毒性休克组血Lac、cTn-I、CRP及PCT水平更高,机械通气和使用缩血管药物(去甲肾上腺素、肾上腺素、多巴胺)的比例更高,心率明显增加及MAP明显降低。传统二维超声检测的心功能指标LVEDD、LVESD、LVEF、RVs、RVd在3组之间无显著统计学差异,脓毒症组和脓毒性休克组的E_(2)/A_(2)和E_(3)/A_(3)明显低于对照组,且脓毒性休克组E_(2)/A_(2)明显低于脓毒症组。TDI检测发现,Am、e′、a′在3组中无显著统计学差异;脓毒症组和脓毒性休克组的Sm、Em、Em/Am、s′、e′/a′明显低于对照组,LVMPI和RVMPI在脓毒症组和脓毒性休克组明显高于对照组;脓毒性休克组的Sm、Em/Am、s′、e′/a′低于脓毒症组,但脓毒性休克组的LVMPI明显高于脓毒症。结论传统二维超声和TDI均可早期检测到脓毒症心脏舒张功能异常,而在心脏收缩功能方面,TDI更具优势。

Objective To compare the value of traditional two-dimensional ultrasound and tissue Doppler imaging(TDI)in early identification of septic cardiac dysfunction.Methods Patients diagnosed with sepsis or septic shock in the Department of Critical Care Medicine of the Affiliated Hospital of Zunyi Medical University from January 2015 to January 2017 were enrolled,which divided into sepsis group(n=40)and septic shock group(n=30).Healthy people matched with gender,age and body mass index were used as control group(n=40).relevant ultrasound indicators were collected.Results The heart rate and body temperature of the sepsis group and septic shock group were significantly higher than those of the control group.Mean arterial pressure(MAP)in septic shock group was significantly lower than that in control group.Compared with the sepsis group,the septic shock group had higher levels of Lac,cTn-I,CRP,PCT,a higher proportion of mechanical ventilation and use of vasoconstrictants(norepinephrine,epinephrine,dopamine),a higher heart rate but a significantly lower MAP.There were no significant differences in LVEDD,LVESD,LVEF,RVs and RVd among the three groups.E_(2)/A_(2) and E_(3)/A_(3) in the sepsis group and the septic shock group were significantly lower than those in the control group.E_(2)/A_(2) in the septic shock group was significantly lower than that in the sepsis group.TDI showed that Am,e′and a′were not significantly different among the three groups.in comparison with the control group,Sm,Em,Em/Am,s′,e′/a′were significantly lower in sepsis group and septic shock group,but LVMPI and RVMPI were significantly higher.Comparing with sepsis group,the septic shock group had lower Sm,Em/Am,s′、e′/a′,but higher LVMPI.Conclusion Both traditional two-dimensional ultrasound and TDI can detect early diastolic dysfunction in sepsis,while TDI has more advantages in terms of cardiac systolic function.