Liu Yongjun, Chen Yuee, Chen Jie, Kuang Yukung, Tan Niandi, Jiang Ke, Peng Shuihui, Hu Chunlin
Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China.
Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China.
Int J Gen Med. 2021 Dec 14;14:9647-9655. doi: 10.2147/IJGM.S334442. eCollection 2021.
To observe hemodynamic characteristics in a series of patients with myocardial injury caused by severe COVID-19-related pneumonia.
We continuously collected clinical data from severe COVID-19-related pneumonia patients from the West Campus of Union Hospital in Wuhan and Dongguan People's Hospital in Dongguan to explore the prevalence of myocardial injury and hemodynamic characteristics after circulatory failure. Doppler ultrasound and PiCCO2 were used to evaluate the hemodynamics of each patient, and arterial blood gas analysis was performed at the same time. Pearson correlation analysis was used to clarify the relationship between the parameters.
A total of 376 patients were observed during the study period. Eighty-seven patients had myocardial injury after admission, and the mean time of myocardial injury after admission was 6 (2, 30) days, from which 16 patients developed hemodynamic instability and 15 died of cardiogenic shock or combined with MODS. Cardiac echocardiography found that the LVEF of all patients was in the normal range and that diastolic function was slightly to moderately impaired. The PiCCO2 data showed that the GEF was significantly decreased in all patients. The dpmx was in normal range. EVLWI, SVRI and GEDI were significantly increased in most patients. Pearson correlation analysis showed that cTNI was significantly related to BNP at hemodynamic instability (r = 0.662, p = 0.005); GEF was related to EVLWI (r = -0.572, p = 0.021) and LAC (r = 0.692, p = 0.003); and EVLWI was affected by LVEF (r = -0.564, p = 0.023), LVDF (r = -0.734, p = 0.001) and PVPI (r = -0.524, p = 0.037).
Hemodynamic status after myocardial injury and cardiogenic shock caused by severe COVID-19-related pneumonia was characterized by cardiac preload and increased EVLWI, accompanied by a decline in GEF.
观察一系列由重症新型冠状病毒肺炎相关肺炎导致心肌损伤患者的血流动力学特征。
我们持续收集了武汉协和医院西院区和东莞人民医院的重症新型冠状病毒肺炎相关肺炎患者的临床资料，以探究心肌损伤的患病率及循环衰竭后的血流动力学特征。使用多普勒超声和脉搏指示连续心排血量监测仪（PiCCO2）评估每位患者的血流动力学，并同时进行动脉血气分析。采用Pearson相关分析来阐明各参数之间的关系。
研究期间共观察了376例患者。87例患者入院后发生心肌损伤，入院后心肌损伤的平均时间为6（2，30）天，其中16例患者出现血流动力学不稳定，15例死于心源性休克或合并多器官功能障碍综合征（MODS）。心脏超声心动图发现所有患者的左心室射血分数（LVEF）均在正常范围内，舒张功能轻度至中度受损。PiCCO2数据显示所有患者的全心射血分数（GEF）显著降低。每搏量变异率（dpmx）在正常范围内。大多数患者的血管外肺水指数（EVLWI）、全身血管阻力指数（SVRI）和全心舒张末期容积指数（GEDI）显著升高。Pearson相关分析显示，在血流动力学不稳定时，心肌肌钙蛋白I（cTNI）与脑钠肽（BNP）显著相关（r = 0.662，p = 0.005）；GEF与EVLWI（r = -0.572，p = 0.021）和乳酸（LAC）（r = 0.692，p = 0.003）相关；EVLWI受LVEF（r = -0.564，p = 0.023）、左心室舒张功能（LVDF）（r = -0.734，p = 0.001）和肺血管通透性指数（PVPI）（r = -0.524，p = 0.037）影响。
重症新型冠状病毒肺炎相关肺炎导致的心肌损伤和心源性休克后的血流动力学状态特征为心脏前负荷增加和EVLWI升高，同时伴有GEF下降。
Zotero 插件