| Objectives: The parameters of minimally invasive hemodynamic monitoring(pulse contour method)were used as controls to observe and analyze the difference of peripheral vascular resistance between patients with distributed shock and patients with non-distributed shock,and to compare and discuss the clinical practical value of using bedside ultrasound to measure peripheral vascular resistance.Methods: This study was a single-center,prospective,clinical cohort study.A total of 61 cases of shock patients in the Department of Emergency Medicine of the First Affiliated Hospital of Kunming Medical University from March 2021 to December2022 were observed.Bedside ultrasound examination was performed at the time points of diagnosis of shock(T0),antishock treatment(T1)and antishock treatment(T2),respectively,to measure bilateral radial arteries.We monitored the Snuffbox Resistive Index(SBRI),the peripheral Perfusion Index(PI),peak systolic velocity(PSV),and end-diastolic velocity(EDV).Cardiac ultrasound monitoring the left ventricular outflow trace-atrial Velocity time integral(VTI),left ventricular diastolic function(Eatly/Atrial,E\A)and Inferior Vena Cave(IVC)allows atrial fibrillation(atrial,E\A).Norepinephrine dose,vital signs Pulse(P),Respiratory Rate(RR),Blood Pressure(Blood Pressure),respiratory rate(P)and respiratory rate(P)were recorded.BP),Pulse Oximeter Oxygen Saturation(Sp O2),Centre Venous Pressure(CVP)monitoring by indwelling dual deep venous veins,Connected Vigileo recorded Cardiac Index(CI),Cardiac Output(CO),Stroke Volume(SV),Stroke Volume Variation(Stroke Volume variation),SVV),Stroke Volume Resistance Index(SVI),Systemic Vascular Resistance,SVR),Systemic Vascular Resistance Index(SVRI)and other monitoring values.Patients were divided into groups A(distributed shock group n=30 cases)and B(non-distributed shock group n=31 cases)according to the values of SVRI.Laboratory indicators were recorded: Data collection was discontinued when Lactic acid Lac,lactic creatinine Scr,and lactic Brain Natriuretic Peptide BNP were kept until the patient had corrected shock or died(T3).The changes of radial artery ultrasound parameters during shock treatment were compared between the two groups.65 healthy volunteers recruited from the physical examination Center of Kunming Medical University were taken as the control,and SBRI,PI,PSV,EDV and other indexes were observed as references.Results: 1.A total of 65 healthy volunteers were enrolled,including 37 males and 28 females,with an average age of 56.35±15.17.The average SBRI of the healthy volunteers was 0.66±0.05.A total of 61 patients with shock were enrolled,including 41 males and 20 females,with an average age of 61.339±14.54.The mean SBRI of shock patients was 0.86+0.01.There were no statistically significant differences in gender and age between the two groups(P>0.05),while there were statistically significant differences in PI,PSV and EDV between the two groups(P<0.05).In the process of T0 to T2,SBRI values of shock patients were all higher than those of healthy volunteers,and there were statistically significant differences between the two groups(P<0.05),suggesting that the SBRI of shock group was higher than that of healthy volunteers.2.From T0 to T3,the heart rate of group A and group B decreased,and P in group B was significantly higher than that in group A at each time point.The changes were statistically significant(P<0.05),and the differences between the two groups were statistically significant(P<0.05).The urine volume,VTI,SV and SVI of the two groups were increased,and the changes were statistically significant(P<0.05).The differences between the two groups were statistically significant(P<0.05),and the SV and SVI of the two groups were increased.The changes were statistically significant(P<0.05),SV and SVI of group A were higher than those of group B at all time points from T0 to T3.There was statistical difference between the two groups(P<0.05).From T0 to T3 A,CO showed a downward trend,while CO in group B showed an upward trend,the change was statistically significant(P<0.05),and there was a statistical difference between the two groups(P<0.05).From T0 to T3,RR,Lac,Scr,IVC and SVV in groups A and B showed a decreasing trend,with statistical difference(P<0.05),while there was no statistical difference between the two groups(P>0.05),systolic blood pressure,PSV,diastolic blood pressure and SP02 showed an increasing trend,with no statistical significance(P>0.05).There was no significant difference between the two groups(P>0.05).3.From T0 to T3,SBRI value of patients in group B was higher than that in group A,and there was A statistical difference between the two groups(P < 0.05).SVR and SVRI of patients in group A showed an upward trend,while SVR and SVRI of patients in group B showed a downward trend without statistical significance(P >0.05).From T0 to T3,the SBRI value of patients in group B was higher than that of group A.There was statistical difference between the two groups(P < 0.05).PI of patients in group A and group B showed A downward trend without statistical significance(P > 0.05),the value of group B was higher than that of group A at each time point,and there were statistical differences between the two groups(P < 0.05).From T0 to T3,EDV and CI of patients in group A showed a downward trend,while EDV and CI of patients in group B showed an upward trend.There was no statistical significance(P > 0.05),EDV and CI of group A were higher than those of group B at each time point,and there were statistical differences between the two groups(P <0.05).4.The optimal cut-off value for diagnosing distributed shock by SBRI was 0.86,P < 0.001.Under ROC curve,AUC was 0.98,sensitivity was 0.9 and specificity was0.97.5.There is a correlation between SBRI and SVRI(P < 0.05),and r value is 0.6,showing a good positive correlation between them.In addition,SBRI is correlated with PI,EDV,CVP,VTI,CO,CI,SVR and urine volume(P < 0.05).The r values of PI,CVP,VTI,CI and SVR were 0.38,0.35,0.39,0.3 and 0.28,respectively,showing a positive correlation.The r values of EDV,CO and urine volume were-0.63,-0.67and-0.44,respectively,showing a negative correlation.Conclusions: 1.There is a good correlation between SBRI and SVRI,which can be used as an indicator to monitor peripheral vascular resistance.2.SBRI can distinguish distribution,the early diagnosis of patients with shock index distribution.3.SBRI reflects the treatment efficiency can be used as shock therapy clinical indicators. |
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