血管麻痹评估在感染性休克患者中的意义
Clinical role of evaluating vascular paralysis in septic shock patients
目的 探讨感染性休克患者血管麻痹对预后及组织灌注的影响.方法 回顾分析2010年1月至2011年7月北京协和医院重症医学科连续收治的感染性休克患者73例.根据28 d生存状况分存活组和死亡组,记录初始血流动力学参数、动脉血乳酸、APACHEⅡ评分及28 d生存状况.结果 死亡组初始急性生理学与慢性健康(APACHE)Ⅱ评分高于存活组,(14.6±5.6)分比(20.4±4.8)分,P<0.01;每搏外周血管阻力指数(SSVRI) (212.7 ±52.6)比(185.4 ±50.5)、脉压每搏指数比值(PP/SVI) (2.8 ±0.7)比(2.5±0.6),有效主动脉弹性指数(EaI)(5.0±1.2)比(4.3±1.1),24、72 h乳酸清除率(rLac)以及7 rLac均显著低于存活组,(18.4±46.4)比(21.5 ±49.7),(19.9±49.6)比(-21.5 ±46.3),(35.5±45.8)比(-59.5 ±64.5),P<0.05.SVRI,SSVRI,PP/SVI及EaI均与24、72 rLac及7 rLac相关,P<0.01.结论 感染性休克患者血管麻痹时,SVRI,SSVRI,PP/SVI及EaI与预后及组织灌注相关,其中SSVRI,PP/SVI及EaI相关性更强.
更多Objective To explore the effects of vascular paralysis upon prognosis and tissue perfusion in septic shock patients.Methods A total of 73 septic shock patients consecutively admitted into our department from January 2010 to July 2011 were retrospectively studied.Their hemodynamic data,arterial lactate concentration and APACHE Ⅱ (acute physiology and chronic health evaluation Ⅱ) score at the beginning of cardiac output monitoring (0 h),as well as the outcome of Day 28 post-diagnosis were recorded.Stroke volume index (SVI) and cardiac index (CI) were obtained through transpulmonary thermodilution technique by pulse induced continuous cardiac output (PiCCO) system.Results (1)APACHE Ⅱ score at 0 h was higher in non-survivors than those in survivors ((14.6 ± 5.6) vs (20.4 ±4.8),P <0.01).Stroke systemic vascular resistance index (SSVRI),pulse pressure/stroke volume index (PP/SVI),effective arterial elastance index (EaI),24 h lactate clearance rate (24 rLac),72 h lactate clearance rate (72 rLac)and 7 d lactate clearance rate (7 rLac)in non-survivors were all lower than those in survivors (P < 0.05) ; (2) SVRI,SSVRI,PP/SVI and EaI were all correlated significantly with 24 rLac,72 rLac and 7 rLac [(212.7 ± 52.6) vs (185.4 ± 50.5),PP/SVI:(2.8 ± 0.7) vs (2.5 ± 0.6),EaI:(5.0 ±1.2) vs (4.3 ±1.1),24/72/7 rLac:(18.4 ±46.4) vs (21.5 ±49.7),(19.9 ±49.6) vs (-21.5 ± 46.3),(35.5 ± 45.8) vs (-59.5 ± 64.5),P < 0.00].Conclusion Vascular paralysis is correlated with prognosis and tissue perfusion in septic shock patients.And SSVRI,PP/SVI and EaI are more significant.
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