早期液体复苏前后血流动力学参数对脓毒性休克患者短期预后的预测价值研究

摘要

Objective To assess the early predictive value of hemodynamic parameters before and after early fluid resuscitation on short-term prognosis of patients With septic shock. Methods We made a retrospective analysis on the data of 47 patients With septic shock Who Were admitted into Beijing Shijitan Hospital from January to December in 2013. General data and hemodynamic parameters of monitored by PICCO Were collected,including CI,GEDI,SVRI,ELWI,PVPI before and six hours after early fluid resuscitation. According to survival or death on day 7,the patients Were divided into survival group and death group. The tWo groups Were compared by hemodynamic parameters,and ROC curves Were plotted. The early predictive value of hemodynamic parameters in prognosis Was analyzed. Results ( 1 )Within 7 days after early fluid resuscitation,21 patients died With a mortality rate of 44. 7%. Apart from SVV,the tWo groups Were not significantly different(P >0. 05)in the rest hemodynamic parameters before early fluid resuscitation;the tWo groups Were significantly different(P<0. 05)in SVI,MAP, GEF,ELWI,PVPI and CFI six hours after early fluid resuscitation. (2)ROC curve shoWed that the AUC of ELWI predicting prognosis six hours after early fluid resuscitation Was the maximum,Which Was 0. 898,and the cut-off value Was 9. 5 ml/kg, With a sensitivity of 76. 2% and a specificity of 92. 3%. The AUC of PVPI predicting prognosis six hours after early fluid resuscitation Was 0. 842,and the cut -off value Was 1. 75,With a sensitivity of 66. 7% and a specificity of 96. 2%. (3) Multivariate logistic regression analysis shoWed that ELWI had a statistic value in the prognosis six hours after early fluid resuscitation(P<0. 05). Conclusion PICCO monitored indexes such as MAP,PVPI and ELWI have certain predictive value for septic patients. ELWI six hours after early fluid resuscitation is an early-stage independent prognostic factor for the short-term prognosis of patients With septic shock.%目的：评估监测早期液体复苏前后血流动力学参数对脓毒性休克患者短期预后的早期预测价值。方法回顾性分析2013年1—12月北京世纪坛医院收治的脓毒性休克患者47例，统计患者一般资料和脉搏指数连续心输出量（PICCO）监测的血流动力学参数，记录早期液体复苏前、复苏后6 h的心指数（CI）、全心舒张末期容积指数（GEDI）、外周血管阻力指数（SVRI）、血管外肺水指数（ELWI）、肺毛细血管通透性指数（PVPI）等血流动力学参数。根据患者7d的存活情况，分为存活组和死亡组，比较两组血流动力学参数的差异，并绘制受试者工作特征（ROC）曲线，分析血流动力学各参数对预后的早期预测价值。结果（1）7 d内死亡21例，病死率为44.7%。两组早期液体复苏前除每搏量变异（SVV）外，其余血流动力学参数比较差异均无统计学意义（P>0.05）；而液体复苏后6 h每搏量指数（ SVI）、平均动脉压（ MAP）、全心射血分数（ GEF）、ELWI、PVPI和心功能指数（ CFI）比较差异有统计学意义（P<0.05）。（2）血流动力学各指标预测预后的ROC曲线图显示，早期液体复苏后6 h的ELWI预测患者预后结局的AUC最大为0.898，切点值为9.5 ml/kg，在此截点值下灵敏度为76.2%，特异度为92.3%。早期液体复苏后6 h的PVPI预测患者预后结局的 AUC 为0.842，切点值为1.75，在此截点值下灵敏度为66.7%，特异度为96.2%。（3）多因素Logistic回归分析结果显示，早期液体复苏后6 h的ELWI水平对预后判断有统计学意义（ P<0.05）。结论 PICCO监测的血流动力学参数PVPI、ELWI、MAP与脓毒性休克患者的预后相关，早期液体复苏后6 h的ELWI水平是评估脓毒性休克患者短期预后的早期独立预测因素。