右心衰竭对脓毒性休克容量反应性的影响

The effect of right heart failure on fluid responsiveness in septic shock

目的研究右心衰竭对脓毒性休克容量反应性的影响。方法16例脓毒性休克患者,按照右心衰竭诊断标准将研究对象分为脓毒性休克不合并右心衰竭组(7例)和脓毒性休克合并右心衰竭组(9例)。收集研究对象的一般资料,并进行中心静脉压(CVP)测定、重症心脏超声检查。比较两组患者的年龄、性别、急性生理学及慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、左室射血分数(LVEF)、右心室舒张末面积(RVEDA)、左心室舒张末面积(LVEDA)、RVEDA/LVEDA、补液前血流速度时间积分(VTI)、补液后VTI、ΔVTI。结果两组年龄、性别、APACHEⅡ评分、SOFA评分、LVEF、LVEDA、补液前VTI、补液后VTI比较无统计学差异(P>0.05)。脓毒性休克不合并右心衰竭组的RVEDA(2.00±0.35)cm2小于脓毒性休克合并右心衰竭组的(2.42±0.35)cm2,RVEDA/LVEDA(0.47±0.03)低于脓毒性休克合并右心衰竭组的(0.62±0.02),ΔVTI(20.83±8.35)%高于脓毒性休克合并右心衰竭组的(11.40±7.06)%,差异有统计学意义(P<0.05)。结论右心衰竭对脓毒性休克容量反应性有影响。

Objective To study the effect of right heart failure on fluid responsiveness in septic shock.Methods 16 patients with septic shock were divided into septic shock without right heart failure group(7 cases)and septic shock with right heart failure group(9 cases)according to the diagnostic criteria of right heart failure.The general data of the subjects were collected,and the central venous pressure(CVP)was measured and severe cardiac ultrasound was performed.Both groups were compared in terms of age,gender,Acute Physiology and Chronic Health Evaluation(APACHEⅡ)score,Sequential Organ Failure Assessment(SOFA)score,left ventricular ejection fraction(LVEF),right ventricular end-diastolic area(RVEDA),left ventricular end-diastolic area(LVEDA),RVEDA/LVEDA,pre-rehydration velocity time integral(VTI),post-rehydration VTI,andΔVTI.Results There was no statistical difference in the comparison of age,gender,APACHEⅡscore,SOFA score,LVEF,LVEDA,pre-rehydration VTI,and post-rehydration VTI between the two groups(P>0.05).The RVEDA was(2.00±0.35)cm2 in septic shock without right heart failure group,which was smaller than(2.42±0.35)in septic shock with right heart failure group;the RVEDA/LVEDA was(0.47±0.03)in septic shock without right heart failure group,which was lower than(0.62±0.02)in septic shock with right heart failure group;theΔVTI was(20.83±8.35)%in septic shock without right heart failure group,which was higher than(11.40±7.06)%in septic shock with right heart failure group;the difference was statistically significant(P<0.05).Conclusion Right heart failure has an effect on fluid responsiveness in septic shock.