Weng Li, Liu Yong-tai, Du Bin, Zhou Jian-fang, Guo Xiao-xiao, Peng Jin-min, Hu Xiao-yun, Zhang Shu-yang, Fang Quan, Zhu Wen-ling
Crit Care. 2012 May 3;16(3):R71. doi: 10.1186/cc11328.
Left ventricular (LV) dysfunction is common in septic shock. Its association with the clinical outcome is still controversial. Tissue Doppler imaging (TDI) is a useful tool to quantify LV function; however, little knowledge is available about the prognostic value of these TDI variables in septic shock. Therefore, we performed this prospective study to determine the role of TDI variables in septic shock.
Patients with septic shock in a medical intensive care unit were studied with transthoracic echocardiography with TDI within 24 hours after the onset of septic shock. Baseline clinical, laboratory, and echocardiographic variables were prospectively collected. Independent predictors of 90-day mortality were analyzed with the Cox regression model.
During a 20-month period, 61 patients were enrolled in the study. The 90-day mortality rate was 39%; the mean APACHE IV score was 84 (68 to 97). Compared with survivors, nonsurvivors exhibited significantly higher peak systolic velocity measured at the mitral annulus (Sa) (11.0 (9.1 to 12.5) versus 7.8 (5.5 to 9.0) cm/sec; P < 0.0001), lower PaO2/FiO2 (123 (83 to 187) versus 186 (142 to 269) mm Hg; P = 0.002], higher heart rate (120 (90 to 140) versus 103 (90 to 114) beats/min; P = 0.004], and a higher dose of norepinephrine (0.6 (0.2 to 1.0) versus 0.3 (0.2 to 0.5) μg/kg/min; P = 0.007]. In the multivariate analysis, Sa > 9 cm/sec (hazard ratio (HR), 5.559; 95% confidence interval (CI), 2.160 to 14.305; P < 0.0001), dose of norepinephrine (HR, 1.964; 95% CI, 1.338 to 2.883; P = 0.001), and PaO2/FiO2 (HR, 0.992; 95% CI, 0.984 to 0.999; P = 0.031) remain independent predictors of 90-day mortality in septic-shock patients.
Our study demonstrated that LV systolic function as determined by TDI, in particular, Sa, might be associated with mortality in patients with septic shock.
左心室（LV）功能障碍在感染性休克中很常见。其与临床结局的关联仍存在争议。组织多普勒成像（TDI）是量化左心室功能的有用工具；然而，关于这些TDI变量在感染性休克中的预后价值，人们了解甚少。因此，我们进行了这项前瞻性研究，以确定TDI变量在感染性休克中的作用。
对入住医疗重症监护病房的感染性休克患者在感染性休克发作后24小时内进行经胸超声心动图检查及TDI检查。前瞻性收集基线临床、实验室和超声心动图变量。采用Cox回归模型分析90天死亡率的独立预测因素。
在20个月的研究期间，共纳入61例患者。90天死亡率为39%；平均急性生理与慢性健康状况评分系统IV（APACHE IV）评分为84分（68至97分）。与幸存者相比，非幸存者在二尖瓣环处测得的收缩期峰值速度（Sa）显著更高（11.0（9.1至12.5）cm/秒对7.8（5.5至9.0）cm/秒；P<0.0001），动脉血氧分压/吸入氧分数值（PaO2/FiO2）更低（123（83至187）mmHg对186（142至269）mmHg；P = 0.002），心率更高（120（90至140）次/分钟对103（90至114）次/分钟；P = 0.004），去甲肾上腺素剂量更高（0.6（0.2至1.0）μg/kg/分钟对0.3（0.2至0.5）μg/kg/分钟；P = 0.007）。在多变量分析中，Sa>9 cm/秒（风险比（HR），5.559；95%置信区间（CI），2.160至14.305；P<0.0001）、去甲肾上腺素剂量（HR，1.964；95%CI，1.338至2.883；P = 0.001）和PaO2/FiO2（HR，0.992；95%CI，0.984至0.999；P = 0.031）仍是感染性休克患者90天死亡率的独立预测因素。
我们的研究表明，TDI测定的左心室收缩功能，尤其是Sa，可能与感染性休克患者的死亡率相关。
