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赵浩天,任珊,龙玲,燕亚茹,申丽旻,赵鹤龄.心肺超声评估脓毒症休克合并心肌功能障碍患者肺水肿[J].中国医学影像技术,2022,38(8):1166~1171

心肺超声评估脓毒症休克合并心肌功能障碍患者肺水肿

Cardiopulmonary ultrasound in evaluating pulmonary edema in patients with septic shock complicated with myocardial dysfunction

投稿时间：2022-01-21 修订日期：2022-05-01

DOI：10.13929/j.issn.1003-3289.2022.08.009

中文关键词: 休克,脓毒性肺水肿超声检查心脏功能试验

英文关键词:shock, septic pulmonary edema ultrasonography heart function tests

基金项目:河北省医学科学研究课题计划(20211264)。

作者	单位	E-mail
赵浩天	河北省人民医院超声科,
任珊	重症医学科, 河北石家庄 050000
龙玲	重症医学科, 河北石家庄 050000
燕亚茹	石家庄市人民医院超声科, 河北石家庄 050000
申丽旻	重症医学科, 河北石家庄 050000
赵鹤龄	重症医学科, 河北石家庄 050000	zhheling@sina.com

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中文摘要:

目的观察心肺超声评估脓毒症休克合并心肌功能障碍(SIMD)患者肺水肿(PE)的价值,分析肺超声评分(LUS)与脉波指示剂连续心排血量(PiCCO)指标血管外肺水指数(EVLWI)及氧合指数的相关性。方法回顾性分析50例脓毒症休克合并SIMD患者,根据PiCCO结果及肺血管通透性指数(PVPI)将其分为高通透性PE组(EVLWI＞10 ml/kg体质量且PVPI＞3,n=9)、低通透性PE组(EVLWI＞10 ml/kg体质量且PVPI≤3,n=15)及非PE组(EVLWI≤10 ml/kg体质量,n=26);比较组间心肺超声及血气分析参数,包括左心室射血分数(LVEF)、左心房内径(LAD)、左心房面积(LAA)、二尖瓣舒张早期峰值速度(E)、二尖瓣环室间隔/侧壁舒张早期运动速度(室间隔e'/侧壁e')、室间隔E/e'、侧壁E/e'、12分区和8分区LUS (LUS₁₂和LUS₈)及氧合指数等,分析LUS、EVLWI及氧合指数的相关性。以PiCCO结果为标准,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估心肺超声参数评估脓毒症休克合并SIMD患者肺水肿及高通透性肺水肿的效能。结果 3组间E、LAD及LAA总体差异均无统计学意义(P均＞0.05),其余参数总体差异有统计学意义(P均＜0.05)。高、低通透性PE组LVEF、室间隔e'、侧壁e'均低于(P均＜0.01),室间隔E/e'、侧壁E/e'、LUS₁₂、LUS₈均高于非PE组(P均＜0.01);高通透性PE组LUS₁₂、LUS₈、EVLWI均高于低通透性PE组(P均＜0.01),而其LVEF、室间隔e'、侧壁e'、室间隔E/e'、侧壁E/e'差异均无统计学意义(P均＞0.05)。EVLWI与LUS₁₂、LUS₈及氧合指数均相关(r=0.845、0.751、－0.649,P均＜0.001);氧合指数与LUS₁₂、LUS₈均呈负相关(r=－0.794、－0.796,P均＜0.001)。LVEF、室间隔E/e'、侧壁E/e'、LUS₁₂及LUS₈评估脓毒症休克合并SIMD患者PE的AUC分别为0.805、0.864、0.831、0.934及0.868,评估高通透性PE的AUC分别为0.463、0.593、0.585、0.863及0.789。结论心肺超声可用于评价脓毒症休克合并SIMD患者PE;LUS与EVLWI及氧合指数相关。

英文摘要:

Objective To observe the value of cardiopulmonary ultrasound for evaluating pulmonary edema(PE) in septic shock patients complicated with sepsis induced myocardial dysfunction (SIMD), and to analyze the correlation between pulmonary ultrasound score (LUS) and extravascular lung water index of pulse indicator continuous cardiac output (PiCCO) and oxygenation index. Methods Data of cardiopulmonary ultrasound, PiCCO and arterial blood gas of 50 septic shock patients complicated with SIMD were retrospectively analyzed. According to the results of PiCCO and pulmonary vascular permeability index (PVPI), the patients were divided into and high permeability PE group (EVLWI>10 ml/kg and PVPI>3, n=9), low permeability PE group (EVLWI>10 ml/kg and PVPI ≤ 3, n=15) and non-PE group (EVLWI ≤ 10 ml/kg, n=26).Left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left atrial area (LAA), peak velocity of early diastolic mitral valve (E), motion velocity of early diastolic septum/lateral of mitral annulus (ventricular septum e '/lateral e'), ventricular septum E/e', lateral E/e', LUS in 12 and 8 zones (LUS₁₂ and LUS₈), as well as oxygenation index were compared among 3 groups. The correlation of LUS, EVLWI and oxygenation index were analyzed. Receiver operating characteristic (ROC) curves were drawn, and the areas under the curve (AUC) were counted to evaluate the efficacy of cardiopulmonary ultrasound parameters for PE and high permeability PE in sepsis shock patients complicated with SIMD. Results There was no significant difference of E, LAD nor LAA (all P>0.05), while there were significant differences of the other parameters among 3 groups (all P<0.05). LVEF, septum e' and lateral e' of PE patients were lower, while septum E/e', lateral E/e', LUS₁₂, LUS₈ and EVLWI were higher than those in non-PE patients (all P<0.01). LUS₁₂, LUS₈ and EVLWI in high permeability PE group were higher than those in low permeability PE group (all P<0.01), while LVEF, septum e', lateral e', septum E/e' and lateral E/e' were not significantly different between these 2 groups (all P>0.05). Significant correlations existed between EVLWI with LUS₁₂, LUS₈ and oxygenation index (r_s=0.845, 0.751, -0.649, all P<0.001), and the oxygenation index was negatively correlated with LUS₁₂ and LUS₈ (r_s=-0.794, -0.796, both P<0.001). AUC of LVEF, septal E/e', lateral E/e', LUS₁₂ and LUS₈ for predicting PE in septic shock patients complicated with SIMD was 0.805, 0.864, 0.831, 0.934 and 0.868, respectively, for predicting high permeability PE was 0.463, 0.593, 0.585, 0.863 and 0.789, respectively. Conclusion Cardiopulmonary ultrasound could be used to evaluate pulmonary edema in sepsis shock patients complicated with SIMD. LUS was correlated with EVLWI and oxygenation index.

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