摘要目的:分析重症监护病房（ICU）脓毒症患者发生高动力左室射血分数（LVEF）的原因及其对预后的影响。方法:采用回顾性队列研究方法，收集2018年1月至2021年10月江苏大学附属人民医院重症医学科收治的273例脓毒症患者的临床资料，包括性别、年龄、病情严重程度评分、合并症、感染源、生命体征、经胸超声心动图（TTE）参数、液体出入量、血管活性药物剂量、治疗措施及预后指标。根据入ICU 7 d内TTE检查结果将患者分为正常LVEF组（LVEF为0.55~0.70）、低LVEF组（LVEF<0.55）和高动力LVEF组（LVEF>0.70）。比较3组患者临床指标的差异，并采用多因素Logistic回归分析筛选脓毒症患者发生高动力LVEF的危险因素；采用Spearman相关分析确定不同LVEF类型患者病死率与临床变量的相关性。结果:273例患者中，排除入院时存在严重瓣膜病或心肌病及入ICU 7 d内未完成TTE检查者20例，最终253例纳入分析，其中正常LVEF组169例，低LVEF组40例，高动力LVEF组44例。不同类型LVEF患者年龄、序贯器官衰竭评分（SOFA）、中心静脉压（CVP）、心率（HR）、氧合指数（PaO 2/FiO 2）、血乳酸（Lac）、尿量、血管活性药物剂量及高血压、缺血性心脏病、慢性肝病、癌症、有创机械通气、肾脏替代治疗（RRT）比例和脓毒性休克发生率差异均有统计学意义。TTE参数分析显示，高动力LVEF组每搏量（SV）、心排血指数（CI）明显高于正常LVEF组和低LVEF组，全身血管阻力（SVR）明显低于正常LVEF组和低LVEF组，E/A比值亦明显升高；且高动力LVEF组患者90 d病死率明显高于正常LVEF组和低LVEF组〔59.1%（26/44）比24.9%（42/169）、32.5%（13/40），均 P<0.05〕。多因素Logistic回归分析显示，慢性肝病〔优势比（ OR）＝1.712，95%可信区间（95% CI）为0.912~3.234， P<0.001〕、癌症（ OR＝2.784，95% CI为1.296~6.151， P<0.001）、HR（ OR＝1.026，95% CI为1.014~1.038， P<0.001）、血管活性药物剂量（ OR＝1.133，95% CI为1.009~1.291， P<0.001）、有创机械通气（ OR＝2.141，95% CI为1.285~3.651， P<0.001）是ICU脓毒症患者发生高动力LVEF的独立危险因素。相关性分析显示，高动力LVEF、正常LVEF和低LVEF患者病死率与血管活性药物剂量均呈显著正相关（ r值分别为0.251、0.361、0.289，均 P<0.001）；高动力LVEF患者病死率与SVR呈显著负相关（ r＝-0.545， P<0.001）。 结论:慢性肝病、癌症、HR、血管活性药物剂量、有创机械通气是脓毒症患者出现高动力LVEF的独立危险因素。高动力LVEF与脓毒症患者病死率呈正相关，可能与脓毒症血管麻痹导致SVR降低有关。

abstractsObjective:To analyze the causes of hyperdynamic left ventricular ejection fraction (LVEF) in sepsis patients in the intensive care unit (ICU) and its impact on prognosis.Methods:A retrospective cohort study was conducted. The clinical data of 273 sepsis patients admitted to the department of critical care medicine of the Affiliated People's Hospital of Jiangsu University from January 2018 to October 2021 were collected including gender, age, severity score, comorbidities, source of infection, vital signs, transthoracic echocardiographic (TTE) parameters, fluid intake and output, vasoactive drug dose, therapeutic measures and prognostic indicators. The patients were divided into normal LVEF group (LVEF 0.55-0.70), low LVEF group (LVEF < 0.55) and hyperdynamic LVEF group (LVEF > 0.70) according to the TTE examination results within 7 days of ICU admission. The clinical indicators among the three groups were compared and analyzed, and multivariate Logistic regression analysis was used to screen risk factors for the development of hyperdynamic LVEF in patients with sepsis. Spearman correlation analysis was used to determine the correlation between the mortality of different types of LVEF and clinical variables.Results:Among 273 patients, 20 patients with severe valvular or cardiomyopathy at admission and those who did not completed cardiac ultrasound within 7 days of ICU admission were excluded. A total of 253 patients were finally enrolled, including 169 patients in the normal LVEF group, 40 patients in the low LVEF group, and 44 patients in the hyperdynamic LVEF group. There were statistically significant differences in age, sequential organ failure assessment (SOFA) score, central venous pressure (CVP), heart rate (HR), oxygenation index (PaO 2/FiO 2), blood lactate (Lac), urine output, vasoactive drug dose, ratio of hypertension, ischemic heart disease, chronic liver disease, cancer, invasive mechanical ventilation and renal replacement therapy (RRT), and incidence of septic shock among the different types of LVEF groups. TTE results analysis showed that the hyperdynamic LVEF group had higher stroke volume (SV) and cardiac index (CI) than those in the normal LVEF and low LVEF groups, lower systemic vascular resistance (SVR) than that in the normal LVEF and low LVEF groups, and an increased E/A ratio. The 90-day mortality in the hyperdynamic LVEF group was significantly higher than that in the normal LVEF and low LVEF groups [59.1% (26/44) vs. 24.9% (42/169), 32.5% (13/40), both P < 0.05]. Multivariate Logistic regression analysis showed that chronic liver disease [odds ratio ( OR) = 1.712, 95% confidence interval (95% CI) was 0.912-3.234, P < 0.001], cancer ( OR = 2.784, 95% CI was 1.296-6.151, P < 0.001), HR ( OR = 1.026, 95% CI was 1.014-1.038, P < 0.001), vasoactive drug dose ( OR = 1.133, 95% CI was 1.009-1.291, P < 0.001), and invasive mechanical ventilation ( OR = 2.141, 95% CI was 1.285-3.651, P < 0.001) were independent factors for hyperdynamic LVEF in ICU sepsis patients. Correlation analysis showed that the mortality of hyperdynamic LVEF, normal LVEF and low LVEF patients was positively correlated with vasoactive drug dose ( r value was 0.251, 0.361, 0.289, respectively, all P < 0.001). The mortality of the hyperdynamic LVEF patients was negatively correlated with SVR ( r = -0.545, P < 0.001). Conclusions:Chronic liver disease, cancer, HR, vasoactive drugs dose, and invasive mechanical ventilation are independent risk factors for hyperdynamic LVEF in patients with sepsis. Hyperdynamic LVEF is positively associated with mortality in sepsis patients, which may be due to the the decrease of SVR caused by septic vascular paralysis.