| Purpose:The management of septic shock patients guided by monitoring and evaluation is beneficial to early identification of critical condition,timely and effective intervention,and has certain predictive value for prognosis.Analysis of ventricular-arterial coupling parameters based on pulmonary thermal dilution and pulse profile analysis(PICCO),to observe the consistency between the dynamic changes of traditional hemodynamics indexes at different time points.In order to provide a more effective and rapid index for clinical evaluation of hemodynamics,organ function and prognosis of patients with septic shock.And expect it to have some guiding value for clinical treatment.Methods:During the period of October 2018? March 2020,patients with septic shock who were hospitalized in the intensive medicine department of the first central hospital of Bao Ding City were selected in this study.according to the difference between ventricular artery coupling value(Ea/Ees)after initial resuscitation(1h bundle)and ventricular artery coupling value 24 hours after treatment.The cardiac index(CI),stroke index(SVI),peripheral end diastolic volume index(GEDI),arterial effective elastic index(Ea I),ventricular effective elastic index(Ees I),ventricular effective elastic index(Ea/Ees),blood lactic acid,BNP,SOFA score were observed and compared between the two groups at0 h,24h,48 h,72h and 72 h,respectively.APACHEII score and other organ function indexes and 28-day mortality rate of patients.The trend and statistical difference between the two groups of samples at different time points of the same index,as well as the correlation between variables andthe trend of change were analyzed.The methods used to evaluate hemodynamics in patients with septic shock are mainly cardiac ultrasound,PICCO and Swan Ganz catheter,but each has some limitations.Results:1.A total of 55 patients with septic shock were included in this study.There were 30 cases in uncouple group and 25 cases in couple group,and there was no statistically significant difference in age,height and weight between the two groups(P=0.322,0.256,0.417,0.278).The both groups suggested that the difference between the two groups was statistically significant(P=0.033).2.As shown in Fig.2 and Fig.1,the SOFA score,APACHEII score and Lac?BNP of the uncouple group were significantly higher than those of the uncouple group at 0 h ? 24 h ? 48 h ? 72 h,The difference was statistically significant(P < 0.05).The CI values of the couple group were significantly higher than those of the uncouple group at 24h?48h?72h,The difference was statistically significant(P=0.023,0.015,0.001).The Ea I? Ees I value of couple group was higher than that of uncouple group,The difference was statistic significant(P < 0.05).There was no significant difference in the remaining items.3.For the purpose of exploring the risk factors associated with28-day mortality,the above indexes were analyzed by using stepwise Logistic regression.As shown in the Fig.4 and Fig.5,The 24h?Ea/Ees and 24 h APACHEII scores were correlated with the 28 day mortality,and the area under the curve was 0.768 and 0.818,respectively.The results of the above analysis suggest that the specificity of the two indicators is high,that is,24 h APACHEII score and 24h?Ea/Ees two indicators can be used as a risk factor to predict the mortality of patients with septic shock in 28 days.4.The results of Pearson correlation analysis showed that the Ea/Ees with 24 h CI ? 24 h,48h,72h?SWI ? 24h?SVI ? 24 h,48h,72h?SOFA ?48h,72h?Lac?72h?BNP and ?72h Ea/Ees showed negative correlation.And with 24h?GEDVI ? ?APACHEII scores and 24h?Lac showed positive correlation.Conclusions:VAV-Arterial coupling can better evaluate hemodynamics,organ function and 28-day mortality in patients with septic shock.Continuous dynamic monitoring of ventricular-arterial coupling indicators can further guide clinical intervention,improve prognosis and reduce mortality. |
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