Study On The Characteristics And Clinical Value Of Left Ventricular Diastolic Function In Critically Ill Patients With Unplanned Admission

Objective:This study examined the left ventricular diastolic function in unplanned ICU patients to get a better understanding of the characteristics of left ventricular diastolic function,to locate the crucial site of clinical treatment,and to improve the prognosis.Methods:This is a cross-sectional study,we enrolled the unplanned patients in the department of critical care medicine,Peking Union Medical Hospital from 2018.8 to 2019.3,and evaluated the left ventricular diastolic function by critical ultrasonography.We analyzed different characteristics in three types of left ventricular diastolic function and three grades of left ventricular diastolic dysfunction.Results:Finally,there were 121 patients enrolled in our cross-sectional study.Among them,30%patients had surgery and 70%patients had not.The patients who didn' t do the surgery had higher female rate,history of hypertension or diabetes mellitus or coronary heart disease rate,APACHEII score,left ventricular diastolic dysfunction rate,ICU day,poor prognosis rate.There were 74 patients(61%)normal with diastolic function,28 patients(23%)with indeterminate diastolic function and 19 patients(16%)with left ventricular diastolic dysfunction.And 15 patients left ventricular systolic dysfunction in left ventricular diastolic dysfunction.The ages of patients were 56,68,66(P=0.079).Those patients who had a history of hypertension or diabetes mellitus or coronary heart disease were diagnosed with left ventricular diastolic dysfunction more than the normal:42%,61%,68%(AC,P?0.001);22%,39%,53%(AC,P?0.001);16%,46%,63%(AC,P?0.001).E',E/E',LAVI and TRmax were higher in patients with left ventricular diastolic dysfunction than the normal,the values were 10cm/s,9cm/s,7cm/s(AC,P<0.05);8,9,10(AC,P<0.05);29ml/m2,39ml/m2,42ml/m2(AC)P<0.05);1.5m/s,1.7m/s,1.9m/s(AC,P<0.05).Indeterminate diastolic function patients had higher blood pressure but the same VTI compared with the normal.Although the OI had no difference in three groups,the mechanical ventilation rates were different:73%,61%,95%(P?0.001).The ICU day in left ventricular diastolic dysfunction patients was 14 days,longer than the normal.Patients with left ventricular diastolic dysfunction had a worse outcome than the normal,the poor prognosis rates were 21%and 14%(P?0.001).We graded the 19 left ventricular diastolic dysfunction patients according to left atrium pressure.The proportion of Grade? to Grade?patients was 58%,26%and 16%.The mitral E velocity was 62±21 cm/s,85±18cm/s,107±34cm/s(Grade? VS Grade?,P?0.001).The ratio of short to long diameter from cross-sectional images of IVC was higher in Grade?than Grade? patients,they were 0.8±0.12,0.76±0.11,0.83±0.02(P=0.668).The VTI in three grades of patients was 12±3cm,16±5cm,9±4cm(GradeII VS Grade?,P<0.05).Grade? patients'fluid balance rate in ICU was higher than that in Grade? and Grade?patients(106ml/hr,10ml/hr,-17ml/hr;P<0.05).Blood pressure and heart rate had no differences in three grades patients.The ICU day and poor prognosis rate were longer and higher in Grade? patients than those in the Gradel,whereas the P>0.05.Conclusion:The patients who did no surgery had a worse prognosis,left ventricular diastolic dysfunction may play pretty important role in it.Age,hypertension,diabetes mellitus and coronary heart disease are the important factors that influence the types of left ventricular diastolic function in unplanned ICU patients.Left ventricular relaxation abnormal maybe essential in left ventricular diastolic dysfunction in unplanned ICU treatment.Left ventricular diastolic dysfunction patients have higher mechanical ventilations rates and poorer prognosis,Grade?patients may have the worst prognosis.Preload and after load management affect the left ventricular types and grades,even patients'prognosis.