Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study.
Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study.
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DOI：
10.1186/2036-7902-4-8
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发表时间：
2012-05-04
影响因子：
--
通讯作者：
Grissom CK
中科院分区：
文献类型：
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作者：
Brown SM;Pittman JE;Hirshberg EL;Jones JP;Lanspa MJ;Kuttler KG;Litwin SE;Grissom CK
患有严重脓毒症或脓毒性休克的患者常常表现出明显的心血管功能障碍。我们试图确定经胸超声心动图（TTE）评估的舒张功能障碍的严重程度是否可预测28天死亡率。
在一家三级医院的两个重症监护病房进行的这项前瞻性观察研究中，78例患有严重脓毒症或脓毒性休克的患者（年龄53.2±17.1岁；51%为女性；平均APACHE II评分23.3±7.4）在入住重症监护病房6小时内、18 - 32小时后以及休克缓解后接受了TTE检查。根据改良的2009年美国超声心动图学会指南，使用E、A和e’速度；E/A和E/e’；以及E减速时间来定义左心室（LV）舒张功能障碍。收缩功能障碍定义为射血分数<45%。
27例患者（36.5%）在初次超声心动图检查时存在舒张功能障碍，而47例患者（61.8%）在至少一次超声心动图检查中存在舒张功能障碍。总死亡率为16.5%。在I级舒张功能障碍患者中观察到最高的死亡率（37.5%），在控制年龄和APACHE II评分后，这种影响仍然存在。在初次TTE检查时，I - III级之间中心静脉压（CVP）（11±5 mmHg）没有差异，尽管I级患者接受的静脉输液量较少。
左心室舒张功能障碍在脓毒症患者中很常见。I级舒张功能障碍，但II级和III级舒张功能障碍并非如此，与死亡率增加相关。这一发现可能反映了尽管中心静脉压升高，但在脓毒症早期液体复苏不足，提示TTE在脓毒症复苏中可能具有作用。
Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. In this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2 ± 17.1 years; 51% females; mean APACHE II score 23.3 ± 7.4) with severe sepsis or septic shock underwent TTE within 6 h of ICU admission, after 18 to 32 h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e’ velocities; E/A and E/e’; and E deceleration time. Systolic dysfunction was defined as an ejection fraction < 45%. Twenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5 mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid. LV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.