Sepsis
The dynamic changes of cardiac function and its associated with prognosis in patients with septic shock
Shuo Wang, Caijun Wu, Jun Yang, Ziren Tang
Published 2018-04-10
Cite as Chin J Emerg Med, 2018, 27(4): 389-393. DOI: 10.3760/cma.j.issn.1671-0282.2018.04.011
Abstract
ObjectiveTo investigate the dynamic change of cardiac function in the patients of septic shock and analyze its influence to prognosis.
MethodsA total of 129 patients were enrolled in the investigation using mornitoring the hemodynamics including the contour pulse wave mean artery pressure (MAP), cardiac index (CI) and systemic vascular resistance indes (SVRI). Echocardiography was done 7 days laterenrollment of left ventricular eject fraction (LVEF), E and A peak of mitral blood flow velocity, mitral annulus moving speed (E’) were detected changes. E/A and E/E’ were calculated. According to the 28-day prognosis, all patients were devided into the survival and death group for detecting the risk factors of death.
ResultsIn all patients, hemodynamics detected changes showed the features of septic shock with high output and low vascular risistance. The values of CI in the survival group and death group were (4.30±0.71) L/min/m2 and (4.52±0.91) L/ (min·m2) , repectively,and the values of SVRI were (1 477±297) dyn·s·cm-5·m2 and (1 488±233) dyn·s·cm-5·m2, repectively. There were no significant differences in CI and SVRI were found between the two groups (both P>0.05). When 7 days after admission in hospital, CI [(3.88±0.51) L/ (min·m2) ] was lower and SVRI [(2 044±266) dyn·s·cm-5·m2] was higher compared with those at admission in the survival group with significant differences, between the two intervals (all P<0.05). In the death group, CI decreased to (2.52±0.87) L/(min·m2) and SVRI increased to (3 201±329) dyn·s·cm-5·m2 after admission on the 7th day in hospital, significant differences between the two groups (all P<0.01). There were significantly differenced with LVEF [(69.1±12.5)% vs. (69.5±11.2)%] and E/E’ (8.43±0.59) vs. (8.89±0.64) found between the two groups on the first day in hospital (all P>0.05). Compared with survival group, LVEF significantly decreased (64.4%±16.3)% vs. (54.4±17.6)% and E/E’ (8.73±0.67) vs. (9.97±0.55) , all P<0.01] was significantly decreased in the death group. APACHE II (OR=1.667, 95%CI: 1.322-1.863, P=0.001), LVEF (OR=0.809, 95%CI: 0.612-0.912, P=0.001) and E/E’ (OR=1.219, 95%CI: 1.030-1.501, P=0.006) were detected to be the risk factors by logistic analysis.
ConclusionsIn septic shock patients, both the systolic, and the diastolic cardiac function were found to be significantly abnormal , resulting poor prognosis.
Key words:
Septic shock; Cardiac function; Hemodynamic; Pulse wavecontour; Echocardiography
Contributor Information
Shuo Wang
Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
Caijun Wu
Jun Yang
Ziren Tang