| 摘要: |
| 目的 探讨超声造影定量参数对脓毒症患者器官功能障碍的预测价值。方法 连续纳入2021年8月至2022年4月武汉大学人民医院重症医学科收治的51例脓毒症患者。同时选择10例非脓毒症休克患者作为对照组。于入院24h内使用超声造影技术定量分析患者的肾灌注。根据SOFA评分对脓毒症患者进行分组，入ICU0~24h内SOFA评分＞6为器官功能衰竭严重组，SOFA≤6分为非严重组；入ICU24~48h内SOFA评分增加（ΔSOFA评分≥１）为器官功能恶化组，ΔSOFA评分＜１为未恶化组。根据入ICU后的存活情况对脓毒症患者进行分组，分为死亡组与存活组。比较组间传统循环指标及超声造影定量参数的变化。结果 脓毒症患者与非脓毒症患者的传统循环指标（HR，SAP，MAP，CVP，EF，RI）均无差异，而Lac，PaO2/FiO2 ratio、SOFA评分以及超声造影定量参数（TTP、AUC、PI）有明显差异。器官功能衰竭严重组和非严重组的大循环指标（HR，MAP，EF）无差异，PaO2/FiO2，RI也无差异，而Lac、AUC、PI差异均有统计学意义（p＜0.05)。器官功能恶化组和未恶化组的大循环无差异，PaO2/FiO2、Lac、RI也无差异，而AUC、PI差异均有统计学意义（p＜0.05)。死亡组与存活组的循环指标均无差异。绘制Lac、AUC、PI的ROC曲线预测器官功能严重衰竭，曲线下面积AUC（0.81）及PI（0.75）大于Lac（0.73）。结论 超声造影定量参数能够早于传统循环指标反映器官功能障碍，对器官功能障碍有一定的预测价值，有望成为一种在床旁评估脓毒症患者微循环的无创检查手段。 |
| 关键词: 超声造影 脓毒症 器官功能衰竭 微循环 肾脏 |
| DOI： |
| 投稿时间：2022-12-05修订日期：2022-12-28 |
| 基金项目: |
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| To investigate the predictive value of quantitative parameters of contrast-enhanced renal ultrasound for organ dysfunction in patients with sepsis |
| yufen,liuna,jiangguijun,zhongzhentong,zhanliying,zhouqing |
| () |
| Abstract: |
| Objective To investigate the predictive value of quantitative parameters of contrast-enhanced ultrasound (CEUS) for organ dysfunction in patients with sepsis. Methods Fifty-one patients with sepsis admitted to the Department of Critical Care Medicine of Renmin Hospital of Wuhan University from August 2021 to April 2022 were enrolled. At the same time, 10 non-septic shock patients were selected as the control group. Renal perfusion was quantified by contrast-enhanced ultrasound within 24 hours after admission. Sepsis patients were divided into two groups according to SOFA score: severe organ failure group with SOFA > 6 and non-severe group with SOFA≤6 within 24 hours after admission to ICU. Patients with increased SOFA score (ΔSOFA score ≥1) within 24 to 48 hours after ICU admission were defined as organ function deterioration group, and patients with ΔSOFA score < 1 were defined as non-deterioration group. Patients with sepsis were divided into death group and survival group according to the survival after admission to ICU. The changes of conventional circulation and CEUS quantitative parameters were compared between the two groups. Results There were no significant differences in traditional circulatory parameters (HR, SAP, MAP, CVP, EF, RI) between sepsis patients and non-sepsis patients, while Lac, PaO2/FiO2 ratio, SOFA score and quantitative parameters (TTP, AUC, PI) of contrast-enhanced ultrasound were significantly different. There were no significant differences in HR, MAP, EF, PaO2/FiO2, RI between the severe group and the non-severe group, while Lac, AUC, PI were significantly different (p < 0.05). There was no difference in macrocirculation, PaO2/FiO2, Lac and RI between the deterioration group and the non-deterioration group, while AUC and PI were significantly different (p < 0.05). There were no differences in circulatory parameters between the death group and the survival group. The ROC curve of Lac, AUC and PI was drawn to predict severe organ failure, and the area under the curve AUC (0.81) and PI (0.75) were greater than Lac (0.73).Conclusions Quantitative parameters of contrast-enhanced ultrasound can reflect organ dysfunction earlier than traditional circulatory parameters, and have certain predictive value for organ dysfunction. It is expected to become a non-invasive method for assessing microcirculation in patients with sepsis at the bedside. |
| Key words: contrast-enhanced ultrasound Sepsis Organ failure Microcirculation kidney |
