Zhonghua nei ke za zhi
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Zhonghua nei ke za zhi · Jun 2016
[The influence of left ventricular-arterial coupling on the prognosis of elderly patients with septic shock].
To investigate the influence of left ventricular-arterial coupling(VAC) on clinical prognosis of elderly patients with septic shock. ⋯ Compared with C group, UC group had lower values of left ventricular ejection fraction[(42.43±4.76)% vs (53.17±3.01)%; P<0.01] and cardiac index[(2.36±0.68) L·min(-1)·m(-2) vs (2.93±0.45)L·min(-1)·m(-2); P<0.01]. Yet serum levels of NT-proBNP[lg NT-proBNP 3.93±0.53 vs 3.40±0.63; P=0.004] and cTNⅠ [lg cTNⅠ-0.16±0.68 vs-1.03±0.69; P<0.001] in UC group were higher than those in C group. Moreover, the total fluid volume within 24 hours [(3 806.3±831.4) ml vs (3 142.0±770.0) ml; P=0.016], blood lactate level[(5.61±2.68) mmol/L vs (3.93±1.59) mmol/L; P=0.043] and dose of norepinephrine[(0.630±0.300)μg·kg(-1)·min(-1) vs (0.292±0.234)μg·kg(-1)·min(-1;) P=0.001] in UC group were greater than those in C group, while ScvO2[(60.75±2.91)% vs (64.42±2.19)%; P<0.001] and urine volume per hour[(0.518±0.358)ml vs (0.926±0.678)ml; P=0.007] were less than those in C group. Compared with C group, UC group had a lower 28-day survival rate[43.2%(19/44) vs 9/12; P=0.049]. Ea/Ees ratio was negatively correlated with LVEF, ScvO2(r=-0.686, P<0.001; r=-0.411, P=0.002), positively correlated with NT-proBNP, cTNⅠ(r=0.294, P=0.028; r=0.363, P=0.006), yet no obvious correlation was noticed with blood lactate level(r=0.170, P=0.21). Multiple logistic regression analysis showed that VAC(OR=11.187, 95%CI 2.489-50.285; P=0.002), lactate level (OR=1.727, 95%CI 1.164-2.563; P=0.007) and lg cTNⅠ(OR=0.247, 95%CI 0.079-0.779; P=0.017) were independent risk factors affecting 28-day mortality. Conclutions: In elderly patients with septic shock, left ventricular-arterial uncoupling indicates a lower 28-day survival rate, worse cardiac function and tissue perfusion. Ea/Ees ratio might sever as a predictive indicator of 28-day mortality.