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目的探讨床旁超声测量二尖瓣舒张早期血流峰速度与二尖瓣环舒张早期运动速度比值(E/E’)与严重脓毒症(包括脓毒性休克)患者肺水肿发生的相关性。方法对2014年11月至2015年8月四川大学华西医院重症医学科重症超声数据库中诊断为严重脓毒症并符合研究纳入标准的患者进行资料分析。以肺部超声水肿评分定量肺水肿程度,以壁侧E/E’是否>8分为两组,校正基线后比较整体肺水肿程度差异及肺水肿分布差异;分析急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、收缩功能指标〔射血分数(EF)、二尖瓣环收缩峰速度(Sd)〕、舒张功能指标(E/E’)及容量指标〔剑下长轴下腔静脉直径(IVCd)〕与肺水肿的相关性,并将差异有统计学意义的指标进行多元线性回归分析,检验E/E’是否为肺水肿的危险因素。结果纳入患者82例,E/E’低组与E/E’高组的性别、APACHEⅡ评分、原发病构成、收缩功能及容量状态等基线资料差异无统计学意义。以年龄校正基线一致,发现E/E’高组肺水肿评分高于E/E’低组(P=0.007);两组患者双肺5~6区肺水肿程度无明显差异,E/E’高组双肺1~4区水肿程度高于E/E’低组(P=0.004);E/E’和IVCd是肺水肿发生的独立危险因素(标准化回归系数分别为0.425和0.249,P均<0.05)。结论床旁超声测量的E/E’是严重脓毒症及脓毒性休克患者肺水肿发生的独立危险因素,随着其升高肺水肿程度明显加重。
Objective To investigate the correlation between bedside echocardiography (E / E ’) and pulmonary edema in patients with severe sepsis (including septic shock) by using mitral early diastolic flow velocity and mitral annular early diastolic velocity. Methods The data of patients diagnosed as severe sepsis and meeting the inclusion criteria in the Critical Care Ultrasound Database of West China Hospital of Sichuan University from November 2014 to August 2015 were analyzed. The extent of pulmonary edema was quantified by the pulmonary edema score. The E / E ’of the wall was divided into two groups according to whether the wall E / E’ was> 8. After adjusting for baseline, the differences of the whole pulmonary edema and the distribution of pulmonary edema were compared. The acute physiology and chronic health evaluation system (APACHEⅡ), systolic function index (EF), mitral annulus systolic velocity (Sd), diastolic function index (E / E ’) and volume index IVCd)〕 and pulmonary edema, and the differences were statistically significant indicators of multiple linear regression analysis to test whether E / E ’is a risk factor for pulmonary edema. Results There were no significant differences in the baseline data of 82 patients, E / E ’low group and E / E’ high group, gender, APACHE II score, primary disease constitution, systolic function and volume status. The age-adjusted baseline was consistent and the score of pulmonary edema in E / E ’group was higher than that in E / E’ group (P = 0.007). There was no significant difference in pulmonary edema between groups 5 and 6 in E / E ’ E / E ’and IVCd were independent risk factors for pulmonary edema in the high group (P = 0.004). The standardized regression coefficients were 0.425 and 0.249, P <0.05). Conclusion E / E ’measured by bedside ultrasound is an independent risk factor for pulmonary edema in patients with severe sepsis and septic shock, with the severity of pulmonary edema increased significantly.