2020 年第 8 期 第 15 卷

阻抗心动描记法在判断血流感染患者心功能方面的应用价值 

The value of impedance cardiography in evaluation of cardiac function in patients with bloodstream infection

作者：牛新荣徐丹斌陈东肖东

英文作者：Niu Xinrong Xu Danbin Chen Dong Xiao Dong 

单位：新疆维吾尔自治区人民医院重症医学科，乌鲁木齐830001 

英文单位：Department of Critical Medicine People′s Hospital of Xinjiang Uygur Autonomous Region Urumqi 830001 China

关键词：血流感染；阻抗心动描记法；心功能障碍 

英文关键词：Bloodinfection;Impedancecardiography;Cardiacdysfunction 

• 摘要：

• 目的 探讨阻抗心动描记法（ICG）在判断血流感染患者心功能方面的应用价值。方法 选取2017年7月至2018年7月在新疆维吾尔自治区人民医院重症监护病房住院的病原菌单一菌株血培养阳性且血清B型脑钠肽（BNP）水平＞300 ng/L的患者80例作为研究对象。入院后完善心脏超声检查，根据纽约心脏病协会心功能分级分为Ⅱ级、Ⅲ级和Ⅳ级3组；同时使用ICG检测血流动力学参数，包括每搏输出量（SV）、SV指数（SI）、心输出量、心脏指数、舒张末期容积（EDV）、预射血期、左心室射血时间（LVET）、收缩时间比（STR）、左心室射血分数（LVEF）、加速指数、外周血管阻力（SVR）和胸腔液体量（TFC）。比较不同心功能分级组间上述参数是否存在差异，进行药物干预后检测上述参数是否存在差异，以及上述参数与BNP是否存在相关性。结果 随着心功能分级的增加，患者的心输出量、加速指数逐渐降低，SVR、TFC及BNP水平逐渐升高，3组间两两比较差异均有统计学意义（均P<0.05）。80例患者治疗后心输出量、心脏指数、LVET、加速指数水平高于治疗前［（4.3±1.5）L/min比（3.0±0.9）L/min、（3.18±0.12）L/(min·m2)比（2.29±0.12）L/(min·m2)、（341±8）ms比（302±9）ms、（51±17）1/(100·s2)比（39±26）1/(100·s2)］，预射血期、STR、SVR、TFC及BNP水平低于治疗前，差异均有统计学意义（均P<0.05）。SV、SI、心输出量、LVET、加速指数与BNP水平呈负相关，而预射血期、STR、SVR与BNP水平呈正相关（均P<0.05）。结论 通过ICG监测血流动力学，具有动态性、连续性及无创性，与BNP具有很好的相关性，ICG对心功能不全的诊断具有重要意义。血流感染患者易出现心功能不全，早期使用ICG检测血流动力学参数，可早期发现心功能不全，进而早期治疗及预防脏器功能进行性受损。

• Objective To explore the value of impedance cardiography（ICG） in the evaluation of cardiac function in patients with bloodstream infection. Methods Totally 80 patients with positive blood culture of pathogenic bacteria and single strain, B-type brain natriuretic peptide(BNP)＞300 ng/L in intensive care unit of People′s Hospital of Xinjiang Uygur Autonomous Region were selected; the patients were divided into three groups(grade Ⅱ, grade Ⅲ and grade Ⅳ), according to the classification of cardiac function of New York Heart Association. ICG was used to detect hemodynamic parameters including stroke volume(SV), stroke volume index(SI), cardiac output, cardiac index, end-diastolic volume(EDV), preejection period(PEP), left ventricular ejection time(LVET), shrink time ratio(STR), left ventricular ejection fraction(LVEF), acceleration index(ACI), systemic vascular resistance(SVR) and thoracic fluid volume(TFC). Results The cardiac output and acceleration index of the patients decreased with cardiac function; the SVR, TFC and BNP levels increased, there were significant differences among the three groups(all P<0.05). The levels of cardiac output, cardiac index, LVET and acceleration index after treatment were higher than those before treatment［（4.3±1.5）L/min vs （3.0±0.9）L/min, （3.18±0.12）L/(min·m2) vs （2.29±0.12）L/(min·m2), （341±8）ms vs （302±9）ms, （51±17）1/(100·s2) vs （39±26）1/(100·s2)］; the levels of PEP, STR, SVR, TFC and BNP were significantly lower than those before treatment(all P<0.05). SV, SI, cardiac output, LVET, acceleration index were negatively correlated with BNP; PEP, STR and SVR were positively correlated with BNP(all P<0.05). Conclusions The hemodynamics measured by ICG is dynamic, continuous and noninvasive; it shows a correlation with BNP. ICG is valuable for the diagnosis of cardiac insufficiency in patients with bloodstream infection. ICG is used to detect hemodynamic parameters in the early stage.