Wang Xiao-Ting, Liu Da-Wei, Long Yun, Chai Wen-Zhao, Cui Na, Shi Yan, Zhou Xiang, Zhang Qing
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2008 Jul;47(7):551-5.
To research and analyze the hemodynamic status of refractory septic shock associated cardiac dysfunction.
70 refractory septic shock patients were studied. In the duration of pulmonary artery catheter (PAC)-directed hemodynamic optimization, the patients were divided into a cardiac dysfunction group and a control group. Hemodynamic parameters, arterial blood lactate concentration and APACHE II scores were obtained instantly after the placement of a PAC, then lactate clearance in 24 hours was surveyed and calculated. Subsequently the two groups of patients were regrouped by nonsurvivor and survivors respectively. All the obtained values were analyzed with statistic methods.
37% of the refractory septic shock patients was complicated with cardiac dysfunction. The age of the patients complicated with cardiac dysfunction was significantly higher than that of the patients of the control group. Central venous pressure (CVP), pulmonary artery obstruction pressure (PAOP), pulmonary artery pressure (PAP), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI) and oxygen extraction ratio (O2ext) in the cardiac dysfunction group were significantly different from those in the control group. Cardiac output (CO), cardiac index (CI), oxygen delivery index (DO2I) and mixed venous oxygen saturation (SvO2) were significantly lower than those of the patients in the control group. SvO2 had a strong correlation with CI. If the patients were regrouped by nonsurvivors and survivors, in the patients complicated with cardiac dysfunction APACHE II scores were significantly higher in the nonsurvivors than survivors; the lactate clearance in 24 hours (median--25%) of the nonsurvivors was significantly lower than that of nonresponders (median 22%), P < 0.05. Conclusion (1) In refractory septic shock patients, cardiac dysfunction maybe the main reason leading to bad outcome. (2) Higher CVP and PAOP and lower SvO2 indicate the onset of cardiac dysfunction. (3) The patients with significantly high initial arterial blood lactate level and the low lactate clearance in 24 hours had bad outcome.
研究并分析难治性感染性休克相关心脏功能障碍的血流动力学状态。
对70例难治性感染性休克患者进行研究。在肺动脉导管（PAC）引导的血流动力学优化期间，将患者分为心脏功能障碍组和对照组。放置PAC后即刻获取血流动力学参数、动脉血乳酸浓度和APACHE II评分，然后测量并计算24小时乳酸清除率。随后将两组患者分别按非幸存者和幸存者重新分组。对所有获得的值进行统计学分析。
37%的难治性感染性休克患者合并心脏功能障碍。合并心脏功能障碍患者的年龄显著高于对照组患者。心脏功能障碍组的中心静脉压（CVP）、肺动脉阻塞压（PAOP）、肺动脉压（PAP）、全身血管阻力指数（SVRI）、肺血管阻力指数（PVRI）和氧摄取率（O2ext）与对照组有显著差异。心输出量（CO）、心脏指数（CI）、氧输送指数（DO2I）和混合静脉血氧饱和度（SvO2）显著低于对照组患者。SvO2与CI有很强的相关性。如果将患者按非幸存者和幸存者重新分组，在合并心脏功能障碍的患者中，非幸存者的APACHE II评分显著高于幸存者；非幸存者24小时乳酸清除率（中位数-25%）显著低于未反应者（中位数22%），P<0.05。结论（1）在难治性感染性休克患者中，心脏功能障碍可能是导致不良预后的主要原因。（2）较高的CVP和PAOP以及较低的SvO2表明心脏功能障碍的发生。（3）初始动脉血乳酸水平显著升高且24小时乳酸清除率低的患者预后不良。
