血液动力学参数的预后意义在心脏性休克患者中
David D Berg1, Gurleen Kaur2, Erin A Bohula1
1Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA.
European heart journal. Acute cardiovascular care
|August 28, 2023
概括
低平均动脉压和心脏性休克 (CS) 患者右心房压升高预测死亡率和器官功能障碍. 侵入性血液动力学评估对于CS的预后至关重要.
科学领域:
- 心脏病学 心脏病学
- 临界护理医学 临界护理医学
- 血液动力学 血液动力学
背景情况:
- 使用肺动脉导管进行侵入性血液动力学评估是管理心脏性休克 (CS) 的标准.
- 血液动力学参数可能为CS患者提供关键的预后见解.
研究的目的:
- 评估在CS中呈现出血动力学参数的预后关联.
- 为了确定血液动力学参数和CS的末端器官功能障碍之间的关系.
主要方法:
- 从重症监护心脏学试验网络注册表 (2018-2022) 的数据分析.
- 在心脏重症监护病房入院后24小时内,包括CS患者进行侵入性血液动力学评估.
- 对于死亡率关联和最小平方的逻辑回归意味着对血清乳酸关联的回归.
主要成果:
- 在1473名具有血液动力学数据的CS患者中,低平均动脉压 (MAP),低静脉血压,低系统血管阻力,高右心房压 (RAP),高RAP/肺毛细血管压比率和低肺动脉脉动指数与死亡率相关.
- 这些关联在控制机械循环支持和血管活性-无热点评分后保持一致.
- 鉴定出血动力学参数也与呈现较高的血清乳酸水平相关,表明全身低 perfusion.
结论:
- 在当代CS种群中呈现出血动力学参数与不良结果有关.
- 系统性动脉度降低和右心室功能障碍是CS预后不佳的关键指标.
- 血液动力学评估为预测CS的结果和末端器官功能障碍提供了重要的信息.
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