摘要
目的研究脓毒症患者三尖瓣环收缩期位移(TAPSE)与全心舒张末期容积指数(GEDVI)的关系。方法选择重症监护病房的42名脓毒症患者,通过脉搏指示连续心排血量(PICCO)及床旁超声采集包括GEDVI、心指数(CI)、TAPSE、肺动脉收缩压(PASP)等数据。根据CI结果将患者分为两组:低CI组(CI<3 L·min-1·m-2)和高CI组(CI≥3 L·min-1·m-2),比较两组患者的血流动力学数据,同时分析两组患者各自的GEDVI与TAPSE的相关性。结果低CI组患者的急性生理和慢性健康评估(APACHEⅡ)评分、乳酸水平和去甲肾上腺素(NE)的使用量均高于高CI组,差异均有统计学意义(t分别=2.26、2.69、2.24,P均<0.05);低CI组患者的GEDVI高于高CI组,平均动脉压和TAPSE低于高CI组,差异均有统计学意义(t分别=5.22、2.45、6.23,P均<0.05),两组患者心率、PASP比较,差异均无统计学意义(t分别=0.95、1.63,P均>0.05)。低CI组GEDVI与TAPSE呈负相关(r=-0.71,P<0.05)。低CI组中,ROC分析提示根据TAPSE预测容量不足(GEDVI<680 ml/m2)的ROC曲线下面积为0.89,最佳临界点为1.58 cm,灵敏度为88.00%,特异度为87.50%。高CI组GEDVI与TAPSE未发现明显相关性(r=-0.34,P>0.05)。结论床旁超声得出的TAPSE对心功能降低的脓毒症患者血容量评估有指导价值。
Objective To investigate the relationship between the tricuspid annular plane systolic excursion(TAPSE)and global end-diastolic volume index(GEDVI)in patients with sepsis.Methods Totally 42 patients admitted to the in-tensive care unit with sepsis were screened.Data including GEDVI,cardiac index(CI),TAPSE and pulmonary artery sys-tolic pressure(PASP)were collected by pulse indicating continuous cardiac output(PICCO)and bedside ultrasound.The patients divide into low CI group and high CI group.The hemodynamic data of the two groups were compared,and the cor-relation between GEDVI and TAPSE were analyzed.Results The APACHEⅡscore,Lac level,and NE usage of low CI group were higher than those of high CI group(t=2.26,2.69,2.24,P<0.05).GEDVI of low CI group was higher than that of high CI group,while mean arterial pressure and TAPSE were lower than those of high CI group(t=5.22,2.45,6.23,P<0.05).But the differences in heart rate and PASP between two groups were not statistically significant(t=0.95,1.63,P>0.05).GEDVI was negatively correlated with TASPE in low CI group(r=-0.71,P<0.05).In low CI group,ROC analysis showed that the area under ROC curve of TAPSE for predicting insufficient volume(GEDVI<680 ml/m2)was 0.89,the cut-off value was 1.58 cm,the sensitivity was 88.00%,and the specificity was 87.50%.There was no significant correla-tion between GEDVI and TAPSE in high CI group(r=-0.34,P>0.05).Conclusion The TAPSE obtained by bedside ultrasound has guiding value for the evaluation of blood volume in patients with sepsis with decreased cardiac function.
作者
林忠宇
张晓敏
LIN Zhongyu;ZHANG Xiaomin(Department of ICU,Wenzhou Integrated Traditional Chinese and Western Medicine Hospital,Wenzhou 325000,China)
出处
《全科医学临床与教育》
2021年第8期680-683,共4页
Clinical Education of General Practice
关键词
超声心动图
三尖瓣环
脉搏指示连续心排血量
脓毒症
echocardiography
tricuspid annulus
pulse indicating continuous carcliae output
sepsis
