摘要目的 探讨脓毒症相关心脏收缩功能障碍患者血流动力学的临床特点.方法 脓毒症患者30例根据基础GEF分为心脏收缩功能障碍组和对照组,并以液体复苏前后△CI≥10%作为标准将心脏收缩功能障碍组内分为液体有反应性和液体无反应性两个亚组;比较组间液体复苏前后血流动力学参数变化.结果 30例脓毒症患者中17例患者合并心脏收缩功能障碍.心脏收缩功能障碍组液体复苏前LVSWI、CFI和dPmx均明显低于心脏收缩功能正常组,均P<0.05;患者液体复苏后MAP、CI、CVP和GEDVI均明显升高,均P<0.05;而GEF、LVSWI、CFI和dPmx与液体复苏前比较无明显变化,均P>0.05.76.5%的心脏收缩功能障碍患者有液体反应性,心脏收缩功能障碍组液体有反应性亚组中液体复苏前CVP(CVP0)及液体复苏前后CVP变化值(△CVP)均无统计学差异,P>0.05;但液体复苏前GEDVI(GEDVI0)及液体复苏前后GEDVI变化值(△GEDVI)则明显高于较液体无反应性亚组, P<0.05.结论 心脏收缩功能障碍在脓毒症患者较为常见,GEDVI是评价液体反应性的较好指标.

abstractsObjective To investigate the clinical characteristics of fluid responsiveness in patients with sepsis-related cardiacsystolic dysfunction. Methods Thirty patients with sepsis were divided into cardiacsystolic dysfunction group and control group according to the basic GEF scores.Taking △CI≥10% before and after the fluid resuscitationas standard criteria,the cardiacsystolic dysfunction group was divided into the subgroups with and without fluid responsiveness.The changes of hemodynamics before and after the fluid resuscitation were compared. Results Seventeen of 30 sepsis patients were diagnosed withcardiac systolic dysfunction.The LVSWI,CFI and dPmx in thecardiac systolic dysfunction group were significantly lower than those in the normal cardiac systolic function group before thefluid resuscitation,both P<0.05. After the fluid resuscitation,the MAP,CI,central venous pressure(CVP)and global end-diastolic volume index(GEDVI)significantly increased(all P<0.05),whereas there were no significant changes in GEF, LVSWI,CFI and dPmx compared with those before the fluid resuscitation(all P>0.05).Among the patients with systolic dysfunction,76.5% showed fluid responsiveness.There were no statistically significant differences in the changes of CVP at the baseline(CVP0)and the CVP before and after the fluid resuscitation (△CVP)in the cardiac systolic dysfunction subgroupwithout fluid responsiveness(P>0.05).The change of GEDVI(GEDVI0)before and after the fluid resuscitation and the change of GEDVI before and after resuscitation(△ GEDVI)were significantly higher than those in the subgroup withoutfluid responsiveness (P<0.05).Conclusion Cardiac systolic dysfunction is common in sepsis patients,and GEDVI is a good indicator for evaluating fluid responsiveness.