| Objective In order to understand the correlation and comparative analysis of various hemodynamic indexes of ultrasound and PICCO in patients with septic shock,and to understand the relationship between their volume indexes and NT-pro BNP,and to understand the degree of pulmonary ultrasound B line and the effect of extravascular pulmonary fluid on the prognosis of patients with septic shock the same time.Methods 69 cases of septic shock patients with breathing machine treatment were chosen from January 2017 to February 2019 in intensive medicine 2and intensive medicine 1 of the first affiliated hospital of guangxi medical university.The indicators of bedside ultrasound were recorded as the indicators of PICCO were obtained synchronously in ICUs,respectively.The indicators of the PICCO were the cardiac output,end-diastolic volume index,the variation rate of stroke,extravascular lung water,and the indicators of bedside ultrasonic were cardiac output,left ventricular end-diastolic diameter,inferior vena cava expansion index,lung B lines state.At the same time,the daily test results of serum NT-pro BNP in each septic shock patient were collected.The grade data were first analyzed by spareman correlation method,and the qualitative data were analyzed by Paired t test.Rank sum test was used for rank data.It was used by multivariate binary logistic regression for affecting prognosis of Age,gender,lextravascular lung waterr,B-lines.P < 0.05 was statistically significant.Result The stroke variation rate of PICCO were correlated with inferior vena cava dilatation index,and R was 0.506,P < 0.05.The best cut-off point of inferior vena cava dilatation index with SVV% response volume as the gold standard was 19.55%,the sensitivity and specificity were 75.80% and 80.6%,respectively,and the area under the ROC curve was 0.822,P < 0.01.Extravascular pulmonary fluid measured by PICCO was related to the degree of pulmonary B-lines measured by bedside ultrasound,and R was 0.734,P < 0.05,and vascular permeability was correlated with lung B-line degree,and R was-0.662,P < 0.05.There were statistically significant differences in pulmonary fluid between different pulmonary ultrasound B-lines groups.The globalend-diastolic volume,extravascular pulmonary fluid,and bedside ultrasound measurements of left ventricular end-diastolic diameter and lung B-lines measured by PICCO were all related to NT-pro BNP.Extravascular pulmonary fluid was a prognostic risk factor for patients with hemodynamic instability,and adverse events increased by 0.354 times for each grade,and P < 0.05.Conclusion The two indicators of ultrasound and PICCO in hemodynamic detection had a good correlation in septic shock patients,the both volume indexes were related with NT-pro BNP.In patients with septic shock,the ultrasonic left ventricular end-diastolic diameter was correlated with globalend-diastolic volume index,which could be used for reference to consider the volume state of left ventricular end-diastolic diameter.The stroke variation rate was highly correlated with inferior vena cava dilatation index,and the optimal cut-off point of ROC curve for inferior vena cava dilatation index was19.55%,with high sensitivity and specificity,and so it could be guided clinical evaluation of volumetric reactivity.Extravascular pulmonary fluid was a prognostic risk factor for septic shock,and it should be paid attention to the status of Extravascular pulmonary fluid.Bedside ultrasound accessed to hemodynamic indicators were convenient,fast,and PICCO detection could be dynamic and continuously access to EVLWant indicators.It should be combined with the advantages of both according to the results of both indicators and NT-pro BNP in order to better guide clinical diagnosis and treatment. |
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