Zhang Hong-Min, Wang Xiao-Ting, Zhang Li-Na, He Wei, Zhang Qing, Liu Da-Wei
Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.
Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
Chin Med J (Engl). 2017 May 20;130(10):1169-1174. doi: 10.4103/0366-6999.205856.
Septic cardiomyopathy is a common finding in septic shock patients. The accepted definition of septic cardiomyopathy is often based on the left ventricular ejection fraction (LVEF). The aim of this study was to determine whether the left ventricular longitudinal systolic function was more sensitive than the LVEF in heart function appraisal of septic shock patients.
This was a case-control study conducted at a 40-bed Intensive Care Unit (ICU) of Peking Union Medical College Hospital. Septic shock patients admitted to the ICU were consecutively enrolled in the study group from March 1, 2016 to September 1, 2016. The control group was selected from nonsepsis patients who were admitted to the ICU and were comparable to the study group. Transthoracic echocardiography was performed to obtain the LVEF measurement, mitral annular plane systolic excursion (MAPSE), tissue Doppler velocity measurement of mitral annulus (Sa), and tricuspid annular plane systolic excursion.
The study group consisted of 45 septic shock patients. Another 45 nonsepsis patients were selected as the control group. There was no difference in the LVEF between the two groups (64.6% vs. 67.2%, t= -1.426, P= 0.161). MAPSE in the study group was much lower than in the control group (1.2 cm vs. 1.5 cm, t= -4.945, P< 0.001). Sa in the study group was also lower than in the control group (10.2 cm/s vs. 11.8 cm/s, t = -2.796, P= 0.014).
Compared to the LVEF, longitudinal systolic function might be more sensitive in the detection of cardiac depression in septic shock patients. In the heart function appraisal of septic shock patients with a normal ejection fraction, more attention should be given to longitudinal function parameters such as MAPSE and Sa.
脓毒症性心肌病是脓毒症休克患者的常见表现。脓毒症性心肌病的公认定义通常基于左心室射血分数（LVEF）。本研究的目的是确定在脓毒症休克患者的心功能评估中，左心室纵向收缩功能是否比LVEF更敏感。
这是一项在北京协和医院40张床位的重症监护病房（ICU）进行的病例对照研究。2016年3月1日至2016年9月1日期间入住ICU的脓毒症休克患者连续纳入研究组。对照组选自入住ICU且与研究组具有可比性的非脓毒症患者。进行经胸超声心动图检查以获得LVEF测量值、二尖瓣环平面收缩期位移（MAPSE）、二尖瓣环组织多普勒速度测量值（Sa）和三尖瓣环平面收缩期位移。
研究组包括45例脓毒症休克患者。另外45例非脓毒症患者被选为对照组。两组之间的LVEF无差异（64.6%对67.2%，t = -1.426，P = 0.161）。研究组的MAPSE远低于对照组（1.2 cm对1.5 cm，t = -4.945，P < 0.001）。研究组的Sa也低于对照组（10.2 cm/s对11.8 cm/s，t = -2.796，P = 0.014）。
与LVEF相比，纵向收缩功能在检测脓毒症休克患者的心脏抑制方面可能更敏感。在评估射血分数正常的脓毒症休克患者的心功能时，应更多关注诸如MAPSE和Sa等纵向功能参数。
