摘要
目的 探讨连续无创血流动力学参数监测在脓毒症患者预后预测中的临床价值.方法 前瞻性选取2019年5月至2022年10月内江市第一人民医院收治的135例脓毒症患者,根据住院预后情况分为死亡组(n=32)和生存组(n=103).于液体复苏前(T0)、液体复苏 1h(T1)、液体复苏2 h(T2)、液体复苏4 h(T3)时间点连续监测脓毒症患者无创血流动力学参数[心脏指数、心输出量、每搏输出量(SV)、每搏变异率(SVV)]变化,比较两组患者不同时间点的无创血流动力学参数变化;采用多因素Logistic回归模型分析影响脓毒症患者预后的因素;采用受试者操作特征(ROC)曲线分析心脏指数、心输出量、SV、SVV在脓毒症患者预后预测中的价值.结果 脓毒症患者T1、T2、T3时心脏指数、心输出量、SV、SVV均高于T0时,差异均有统计学意义(P＜0.05);T3时心脏指数、心输出量、SV、SVV低于T2时,差异均有统计学意义(P＜0.05).T1、T2、T3时刻死亡组患者的心脏指数、心输出量、SV、SVV均明显低于生存组,差异均有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,T1、T2、T3时心脏指数、心输出量、SV、SVV均是影响脓毒症患者预后的相关因素(P＜0.05);ROC曲线显示,T3时刻心脏指数、心输出量、SV、SVV联合预测预后的曲线下面积(AUC)值(0.884)最大.结论 无创血流动力学监测指标心脏指数、心输出量、SV、SVV可有效预测脓毒症患者预后,且联合检测预测预后的价值更高.
Abstract
Objective To explore the clinical value of continuous non-invasive hemodynamic parameters monitoring in prognosis predic-tion of patients with sepsis.Methods A prospective study was conducted on 135 patients with sepsis admitted to the First People's Hospital of Neijiang from May 2019 to October 2022.The patients were divided into the death group(n=32)and the survival group(n=103)based on their hospital prognosis.The non-invasive hemodynamic parameters[cardiac index,cardiac output,stroke volume(SV),stroke volume varia-tion(SVV)]at the time points before fluid resuscitation(T0),1 hour after fluid resuscitation(T1),2 hours after fluid resuscitation(T2),and 4 hours after fluid resuscitation(T3)in patients with sepsis were continuously monitored for changes,and the non-invasive hemodynamic param-eter changes at different time points between two groups of patients were compared.The prognostic factors affecting sepsis patients were analyzed u-sing a multivariate Logistic regression model.The prognostic value of cardiac index,cardiac output,SV,SVV were analyzed by receiver operating characteristic(ROC)curve.Results The cardiac index,cardiac output,SV and SVV at T1,T2 and T3 time were higher than those at T0,and the differences were statistically significant(P＜0.05);the cardiac index,cardiac output,SV and SVV at T3 time were lower than those at T2 time,and the differences were statistically significant(P＜0.05).The cardiac index,cardiac output,and SV and SVV in the death group at T1,T2 and T3 time were significantly lower than those in the survival group,and the differences were statistically significant(P＜0.05).Multi-variate Logistic regression analysis showed that cardiac index,cardiac output SV,SVV at T1,T2,and T3 time were all prognostic related factors(P＜0.05).ROC curve shown that the area under the curve(AUC)value of cardiac index,cardiac output,SV,SVV combined to predict prog-nosis at T3 was the largest at 0.884.Conclusion Non-invasive hemodynamic monitoring indicators cardiac index,cardiac output,SV,SVV can effectively predict the prognosis of patients with sepsis and make early fluid resuscitation more reasonable.
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