【摘要】：目的探討床旁超聲測(cè)量二尖瓣舒張?jiān)缙谘鞣逅俣扰c二尖瓣環(huán)舒張?jiān)缙谶\(yùn)動(dòng)速度比值(E/E’)與嚴(yán)重膿毒癥(包括膿毒性休克)患者肺水腫發(fā)生的相關(guān)性。方法對(duì)2014年11月至2015年8月四川大學(xué)華西醫(yī)院重癥醫(yī)學(xué)科重癥超聲數(shù)據(jù)庫(kù)中診斷為嚴(yán)重膿毒癥并符合研究納入標(biāo)準(zhǔn)的患者進(jìn)行資料分析。以肺部超聲水腫評(píng)分定量肺水腫程度,以壁側(cè)E/E’是否8分為兩組,校正基線后比較整體肺水腫程度差異及肺水腫分布差異;分析急性生理學(xué)與慢性健康狀況評(píng)分系統(tǒng)Ⅱ(APACHEⅡ)、收縮功能指標(biāo)〔射血分?jǐn)?shù)(EF)、二尖瓣環(huán)收縮峰速度(Sd)〕、舒張功能指標(biāo)(E/E’)及容量指標(biāo)〔劍下長(zhǎng)軸下腔靜脈直徑(IVCd)〕與肺水腫的相關(guān)性,并將差異有統(tǒng)計(jì)學(xué)意義的指標(biāo)進(jìn)行多元線性回歸分析,檢驗(yàn)E/E’是否為肺水腫的危險(xiǎn)因素。結(jié)果納入患者82例,E/E’低組與E/E’高組的性別、APACHEⅡ評(píng)分、原發(fā)病構(gòu)成、收縮功能及容量狀態(tài)等基線資料差異無(wú)統(tǒng)計(jì)學(xué)意義。以年齡校正基線一致,發(fā)現(xiàn)E/E’高組肺水腫評(píng)分高于E/E’低組(P=0.007);兩組患者雙肺5~6區(qū)肺水腫程度無(wú)明顯差異,E/E’高組雙肺1~4區(qū)水腫程度高于E/E’低組(P=0.004);E/E’和IVCd是肺水腫發(fā)生的獨(dú)立危險(xiǎn)因素(標(biāo)準(zhǔn)化回歸系數(shù)分別為0.425和0.249,P均0.05)。結(jié)論床旁超聲測(cè)量的E/E’是嚴(yán)重膿毒癥及膿毒性休克患者肺水腫發(fā)生的獨(dú)立危險(xiǎn)因素,隨著其升高肺水腫程度明顯加重。
[Abstract]:Objective to investigate the correlation between the peak velocity of mitral early diastolic flow and the ratio of early diastolic velocity of mitral annulus (E / E') and pulmonary edema in patients with severe sepsis (including septic shock) by bedside ultrasound. Methods from November 2014 to August 2015, the data of patients diagnosed as severe sepsis in severe sepsis database of Department of intensive Medicine, West China Hospital of Sichuan University were analyzed. The degree of pulmonary edema was quantified by ultrasonic edema score of lung, and whether the wall side E / E 'was 8 or not was divided into two groups. After correcting the baseline, the differences of the degree of pulmonary edema and the distribution of pulmonary edema were compared. Analysis of acute physiology and chronic health status scoring system 鈪，

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