| Objective:To explore the PiCCO(Pulse-indicator Continous Cardiac Output)parameters change rule of dynamic monitoring and prognosis in patients with septic shock and cardiogenic shock,provide more reliable basis for further clinical applicationMethods:Retrospectively selected 60 patients with septic shock and 56 patients with cardiogenic shock both used pulse indicates a continuous cardiac output(PiCCO)monitoring in September 2013 to June 2016 admitted to the Intensive Care Unit of the hospital of Changsha affiliated to Hunan Normal University(Changsha fourth hospital)and Hunan Ning Xiang people's hospital affiliated to University of traditional Chinese medicine(The people's hospital of Changsha Ning Xiang county).On the basis of 28 days surviving condition,septic shock patients were divided into survival group(n=30)and death group(n=30),cardiac shock patients divided into survival group(n=29)and death group(n=27),collected general data and the hemodynamics indexes such as extravascular lung water index(EVLWI),pulmonary vascular permeability index(PVPI),central venous pressure(CVP),cardiac index(CI),end-diastolic volume index(GEDVI),peripheral vascular resistance(SVRI),mean arterial pressure(MAP)were detected with PiCCO technique in Oh?24h?48h?72h.The levels of above indexes were compared between 2 groups respectively and their predictive values on prognosis were calculated by working characteristic curve(ROC curve)and multiariable logistic regression analysis,analysised the value of the prognosis evaluation of indicators.Results:1.The study on septic shock:In 24h,48h,72h after treatment,Compared with death group,the extravascular lung water index(EVLWI)was significantly lower(t=-5.186?-3.373?-3.368,P<0.05),the index of pulmonary vascular permeability(PVPI)was significantly lower,too(t=-3.469?-2.737?-2.737,P<0.05).Oh after loading the catheter,the ROC analysis showed(1)the EVLWI area under the ROC curve:AUCEVLWI=0.836 with cut-off point at 25ml/kg,the sensitivity and specificity were 65%and 100%.(2)the PVPI area under the ROC curve:AUCPVPI=0.715 with cut-off point at 2.15,the sensitivity and specificity were 70%and 70%;24h after loading the catheter,the ROC analysis showed:(1)the AUCEVLWI=0.913 with cut-off point at 11.2 ml/kg,the sensitivity and specificity were 100%and 85%.(2)the AUCPVPI=0.724 with cut-off point at 2.25,the sensitivity and specificity were 70%and 65%;after loading the catheter 48h,the ROC analysis showed:(1)the AUCEVLWI=0.900 with cut-off point at 12.4 ml/kg,the sensitivity and specificity were 90%and 90%;(2)the AUCPVPI=0.793 with cut-off point at 2.15,sensitivity and specificity were 80%and 70%.After loading the catheter 72h,(1)the AUCEVLWI=0.958 with cut-off point at 11.5 ml/kg,sensitivity and specificity were 100%and 95%;(2)the AUCPVPI=0.898 with cut-off point at 1.55,sensitivity and specificity were 95%and 85%.The value of the area under the ROC curve,sensitivity and specificity of EVLWI,PVPI on 72h to predict prognosis was higher than 0h,24h and 48h.The multiariable logistic regression analysis showed that EVLWI was an independent predictor of prognosis of patients with septic shock.72h can be used as a more effective observation time window to assess prognosis of septic shock2.0n the study of cardiogenic shock:In 24h,48h,72h after treatment,Compared with death group,the extravascular lung water index(EVLWI)was significantly lower(t=-13.623?-17.435?-16.827,P<0.05),the index of pulmonary vascular permeability(PVPI)was significantly lower after loading the catheter 48h(t=-2656,-2.695,-2672,P<0.05).The EVLWI and PVPI level of Survival group and death group are gradually decreased,but the overall level of EVLWI and PVPI in survival group was obviously lower than death group.Oh after loading the catheter,the ROC analysis showed(1)the extravascular lung water index area under the ROC curve AUCEVLWI=0.974 with cut-off point at 16.9ml/kg,the sensitivity and specificity were 85.2%and 96.6%.(2)the PVPI area under the ROC curve AUCPVPI=0.557 with cut-off point at 3.5,the sensitivity and specificity were 25.9%89.7%;24h after loading the catheter,the ROC analysis showed:(1)the AUCEVLWI=0.997 with cut-off point at 13.9 ml/kg,the sensitivity and specificity were 100%and 96.6%.(2)the AUCPVPI=0.438 with cut-off point at 3.7,the sensitivity and specificity were 0%and 100%;after loading the catheter 48h,the ROC analysis showed(1)the AUCEVLWI=1.000 with cut-off point at 12.9 ml/kg,the sensitivity and specificity were 100%and 100%;(2)the AUCPVPI=0.723 with cut-off point at 1.6,sensitivity and specificity were 81.5%and 58.6%.After loading the catheter 72h,(1)the AUCEVLWI=1.000 with cut-off point at 10.1ml/kg,sensitivity and specificity were 100%and 95%;(2)the AUCPVPI=0.515 with cut-off point at 1.2,sensitivity and specificity were 96.3%and 17.2%.The value of the area under the ROC curve,sensitivity and specificity of EVLWI,PVPI on 72h to predict prognosis was higher than Oh?24h and 48h,suggestting the EVLWI levels in 72h is more significance to the evaluation of prognosis prediction.Conclusion:1.In septic shock and Cardiogenic shock,the hemodynamic parameters as EVLWI and PVPI monitored by PiCCO changed significantly,while the other indexes had no significant change,the reason may be that it is still lack of direct and specific intervention methods to EVLWI and PVPI2.The changes of EVLWI and PVPI in septic shock and cardiogenic shock was different,reflected the differences of pathogenesis between septic shock and cardiogenic shock.the,The EVLWI and PVPI had certain relevance in septic shock,it suggested the mechanism of pulmonary water increase in septic shock were closely related with high leakage of lung pulmonary capillaries.3.EVLWI can be used as a independent prediction risk factors of death to patients with septic shock or cardiogenic shock,it has the most significant prection in the 72 hours "time window". |
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