功能性超声心动图参数在新生儿脓毒症休克中的临床应用价值

Value of functional echocardiographic parameters in predicting refractory septic shock in neonates

摘要:

目的 探讨功能性超声心动图参数在新生儿脓毒症休克中的临床应用价值。 方法 纳入72例脓毒症休克新生儿，根据脓毒症休克评分最高值，分为非难治性组（42例）与难治性组（30例），比较2组患儿临床资料、实验室检查结果、功能性超声心动图参数等资料，采用受试者工作特征曲线评价功能性超声心动图参数对脓毒症休克新生儿死亡的预测效能。 结果 难治性组患儿心输出量和心脏指数（cardiac index，CI）低于非难治性组，而平均动脉压与CI比值（mean arterial pressure to cardiac index ratio，MAP/CI）高于非难治性组（均P<0.05）。CI与MAP/CI对脓毒症休克相关死亡的预测界值分别为2.6 L/(min·m²)（灵敏度为79%，特异度为83%，曲线下面积为0.841，P<0.05）和11.4（灵敏度为83%，特异度为73%，曲线下面积为0.769，P<0.05）；CI对脓毒症休克新生儿28 d内全因死亡的预测界值为2.9 L/(min·m²)，灵敏度和特异度均为69%，曲线下面积为0.717（P<0.05）。 结论 CI与MAP/CI有助于临床医生早期预测脓毒症休克新生儿的死亡。

Abstract:

Objective To study the value of functional echocardiographic parameters in predicting refractory septic shock in neonates. Methods A total of 72 neonates with septic shock were enrolled. According to the highest value of septic shock score, they were divided into two groups: refractory (n=30) and non-refractory (n=42). The two groups were compared in terms of clinical data, laboratory findings, and functional echocardiographic parameters. The receiver operating characteristic (ROC) curve was used to evaluate the performance of functional echocardiographic parameters in predicting refractory septic shock. Results Compared with the non-refractory group, the refractory group had significantly lower cardiac output and cardiac index (CI) and a significantly higher mean arterial pressure (MAP)/CI ratio (P<0.05). CI had a cut-off value of 2.6 L/(min·m2), a sensitivity of 79%, a specificity of 83%, and an area under the ROC curve (AUC) of 0.841 in predicting septic shock-related death (P<0.05), and MAP/CI ratio had a cut-off value of 11.4, a sensitivity of 83%, a specificity of 73%, and an AUC of 0.769 (P<0.05). CI had a cut-off value of 2.9 L/(min·m2), a sensitivity of 69%, a specificity of 69%, and an AUC of 0.717 in predicting all-cause death within 28 days (P<0.05). Conclusions CI and MAP/CI ratio can be useful for early prediction of septic shock-related death in neonates.