摘要目的：评价外周血管阻力指数（SVRI）联合血清降钙素原（PCT）水平和序贯器官衰竭评分（SOFA）在脓毒症早期诊断中的临床价值。方法回顾性分析2013年11月至2016年4月广西省河池市第三人民医院重症医学科收治的重症患者临床资料。记录患者性别、年龄、感染部位、SOFA评分；入重症加强治疗病房（ICU）后1h内血清PCT水平（酶联荧光分析法）；入ICU后首次脉搏指示连续心排血量（PiCCO）监测的血流动力学参数〔包括平均动脉压（MAP）、中心静脉压（CVP）、心排血指数（CI）、SVRI、全心舒张期末容积指数（GEDVI）、血管外肺水指数（EVLWI）〕。根据脓毒症诊断标准将重症患者分为脓毒症组和非脓毒症组；脓毒症患者再根据SVRI正常值（170～240kPa·s·L-1·m-2）分为低SVRI组、正常SVRI组、高SVRI组，比较各组间患者各项指标的差异。采用Pearson相关分析SVRI与各指标的相关性。绘制受试者工作特征曲线（ROC），评价各项指标的诊断效能。结果共纳入103例重症患者，脓毒症患者55例，非脓毒症患者48例；与非脓毒症组比较，脓毒症组SVRI水平明显降低（kPa·s·L-1·m-2：146.56±45.17比188.04±56.27），血清PCT水平明显升高（μg/L：10.43±6.17比0.32±0.11），差异均有统计学意义（均P＜0.05）。55例脓毒症患者中，低SVRI组21例，正常SVRI组19例，高SVRI组15例；3组患者性别、年龄、感染部位比较差异无统计学意义，说明基线资料均衡可比。低SVRI组SOFA评分、PCT、CI显著高于正常SVRI组和高SVRI组〔SOFA（分）：10.57±2.89比5.73±2.28、5.73±2.15，PCT（μg/L）：24.15±12.43比7.18±5.05、7.39±4.38，CI（mL·s-1·m-2）：71.01±9.67比62.01±8.34、62.51±8.67，均P＜0.05〕，而正常SVRI组与高SVRI组上述指标差异均无统计学意义。3组患者间MAP、CVP、EVLWI和GEDVI差异也均无统计学意义。Pearson相关分析显示：SVRI与PCT、SOFA评分、CI均呈显著负相关（r值分别为-0.622、-0.598、-0.398，均P＝0.000）。ROC曲线分析显示，PCT联合SVRI诊断脓毒症的ROC曲线下面积（AUC）高于二者单独诊断（0.943比0.911、0.884）；当PCT截断值为3.79μg/L且SVRI截断值为156.81kPa·s·L-1·m-2时，敏感度为94.6%，特异度为92.3%。结论脓毒症患者SVRI与PCT、SOFA评分相关，联合监测PCT、SVRI、SOFA评分能准确反映脓毒症患者病情，以指导诊疗及评估预后。PCT联合SVRI对脓毒症的早期诊断效能优于二者独立诊断。

abstractsObjective To assess the clinical value of systemic vascular resistance index (SVRI) combined with serum procalcitonin (PCT) and sequential organ failure assessment (SOFA) score in the early diagnosis of sepsis. Methods A retrospective study was conducted. The data of critical patients admitted to Department of Critical Care Medicine of the Third People's Hospital of Hechi from November 2013 to April 2016 were enrolled. The clinical data were recorded as follows: gender, age, infection site, SOFA score, serum PCT level (enzyme linked fluorescence analysis) within 1 hour after intensive care unit (ICU) admission, hemodynamics parameters, including mean arterial pressure (MAP), central venous pressure (CVP), cardiac index (CI), SVRI, global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), which were monitored by pulse indicator continuous cardiac output (PiCCO) after ICU admission. The patients were divided into sepsis and non-sepsis groups according to the diagnostic criteria of sepsis. Septic patients were divided into low SVRI group, normal SVRI group, and high SVRI group according to SVRI normal value (170-240 kPa·s·L-1·m-2), and the differences in parameters among the three groups were compared. The correlations between SVRI and various parameters were analyzed by using Pearson correlation analysis. The receiver operating characteristic curve (ROC) was plotted to evaluate the diagnostic efficiency of each parameter. Results Totally 103 critical patients were enrolled, 55 in sepsis group, and 48 in non-sepsis group. Compared with non-sepsis group, SVRI in septic group was significantly lowered (kPa·s·L-1·m-2: 146.56±45.17 vs. 188.04±56.27), and serum PCT was significantly increased (μg/L: 10.43±6.17比0.32±0.11) with statistically significant differences (both P < 0.05). In 55 sepsis patients, there were 21 in low SVRI group, 19 in normal SVRI group, and 15 in high SVRI group. There were no statistically significant differences in gender, age and infection site among the three groups, indicating that the baseline data among all groups was balanced with comparability. SOFA score, PCT, and CI in the low SVRI group were significantly higher than those of normal SVRI and high SVRI groups [SOFA: 10.57±2.89 vs. 5.73±2.28, 5.73±2.15, PCT (μg/L): 24.15±12.43 vs. 7.18±5.05, 7.39±4.38, CI (mL·s-1·m-2): 71.01±9.67 vs. 62.01±8.34, 62.51±8.67, all P < 0.05], but no significant difference was found between the normal SVRI group and high SVRI group. There was no statistically significant difference in MAP, CVP, EVLWI, and GEDVI among the three groups. It was shown by Pearson correlation analysis that SVRI was negatively correlated with PCT, SOFA score, and CI (r value was -0.622, -0.598, -0.398, all P = 0.000). It was shown by ROC curve that area under ROC curve (AUC) of PCT combined with SVRI for diagnosis of sepsis was higher than that of PCT or SVRI alone (0.943 vs. 0.911, 0.884). When the cut-off value of PCT was 3.79 μg/L, and cut-off value of SVRI was 156.81 kPa·s·L-1·m-2, the sensitivity and specificity were 94.6% and 92.3% respectively. Conclusions For sepsis patients, SVRI is related to PCT and SOFA score. Combined monitoring of PCT, SVRI, SOFA score can accurately reflect the severity of sepsis patients, guide diagnosis and treatment, and estimate prognosis. The efficacy of PCT combined with SVRI in the early diagnosis of sepsis is better than that of the two alone.