A Study on the prognosis of patients with early sepsis by valuing dynamic changes of CVP and E/A
10.3969/j.issn.1671-8348.2018.11.011
- VernacularTitle:CVP动态变化结合E/A对早期脓毒症患者预后评估的价值
- Author:
Guifang WEI
1
;
Yinjiang CHANG
;
Xiaoman YANG
;
Yuming DU
Author Information
1. 河南省濮阳市人民医院重症医学科 457000
- Keywords:
central venous pressure;
the prognosis;
sepsis;
E/A
- From:
Chongqing Medicine
2018;47(11):1475-1479,1484
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical values of Dynamic changes of evaluation of central venous pressure (△CVP) combining with the pulse Doppler records of early mitral dilatation of blood flow velocity and peak atrial systolic blood flow velocity ratio (E/A) in the diagnosis and prognosis assessment of septic patients.Methods The study totally enrolled patients who were admitted to Intensive Care Unit of the Central Hospital of Puyang during January 2013 to June 2016.By the standard of 28 days,all the cases were divided into the survival group and the dead group.All patients admitted in the intensive treatment unit (ICU) in the same period were recorded of the acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score and sequential organ failure score (SOFA).Observe the dynamic changes of the two groups of patients on central venous pressure (△CVP) and E/A changes record into the family,after 6 hours and 24 of the related E/A value on each node,at the same time record the related CVP values,calculated the absolute value of the dynamic change of each node in the comparison after 6 h and 24 hours,the records of the node values mapped the receiver-operating characteristic curve (ROC) to evaluate the value of each index for prognosis.Results A total of 233 cases of sepsis patients enrolled,28 d survival of 122 cases,survival rate was 52.4％;111 cases died,mortality was 47.6％.The ICU blood lactate,APACHE Ⅱf,SOFA score of the dead group was significantly higher than the survival group,and their stay in ICU was significantly shorter than the survival group (P＜0.05),other clinical features of the difference was not statistically significant(P＞0.05).The E/A value differences between the dead group and survival group into the ICU 0h and 6h were 0.54±0.17,0.69±0.24;0.57±0.28,0.85±0.25 (P＜0.05),the ROC curve analysis is 0.792,0.818,and there are different CVP change value △h2 CVP change value △h1,24 hours and after 6 hours of the patient,namely:5.67 ± 4.16,7.82 ±4.81;6.58±3.89,8.82±2.40 (P＜0.05) the area under the ROC curve it was,0.778,0.705,wherein when the 6h,the cutoff value E/A 0.75 area taken under the ROC curve (AUC) was 0.818 for the highest single index,the sensitivity and specificity were forecast 74.16％,95.45％,which the ICU 6 when E/A area under the ROC curve of dynamic changes in the value of a ACVP with CVP (AUC) of up to 0.844;0.471 to take their cut-off point,the sensitivity of the prognosis was 88.32％,specificity degree of 90.71％,better predictive strength thanthe other indicators,as well as sensitivity and specificity.Conclusion Early E/A can be used as prognostic evaluation of sepsis as new and important indicator,combining with dynamic changes of the early CVP as an early assessment of the clinical condition of patients with sepsis,and can be prediction of the prognosis of patients,as well as reference for the therapeutic intervention on high-risk patients.
