中文摘要：

目的探讨脉搏指示连续心输出量（PiCCO）监测参数左室每搏做功指数（LVSWI）及左心做功指数（LCWI）在感染性休克救治中的应用价值。方法采用回顾性研究方法，选择早期液体复苏治疗后仍需要血管活性药物维持血压而行PiCCO监测的22例感染性休克患者，根据预后将患者分为存活组和死亡组，收集行PiCCO监测0、8及24h监测数据进行分析。结果存活组和死亡组患者PiCCO各观察参数在0h基线比较差异无统计学意义（P〉0．05）。死亡组患者各参数在24h观察期内没有出现明显的变化，而存活组患者心指数（CI）、心功能指数（CFI）、全心射血分数（GEF）、LVSWI及LCWI升高（P〈0．05）；LVSWI及LCWI与CI、CFI、GEF显著正相关（P〈0．01）；存活组与死亡组患者基线LVSWI[（25．09±11．36）g·m／m2比（18．95±9．69）g·m／m2]及LCWI[（2．95±1．45）kg·m／m2比（2．80±1．90）kg·m／m2]比较差异无统计学意义，存活组患者LVSWI及LC—WI在24h内升高，而死亡组患者无明显变化，两组比较差异有统计学意义（P〈0．05）。结论感染性休克患者在液体复苏过程中存在LVSWI和LCWI低下，PiCCO监测下调整治疗提升LVSWI和LCWI，增加心脏做功，有利于改善预后；而LVSWI和LCWI的持续低下提示预后不良。

英文摘要：

Objective To investigate the value of left ventricular stroke work index （LVSWI） and left cardiac work index （LCWI） derived from pulse index continuous cardiac output （PiCCO） in patients with septic shock. Methods Septic shock patients admitted to the Department of Intensive Care Medicine of the First Affiliated Hospital of Anhui Medical University from June 2012 to March 2016 were enrolled for eligibility. PiCCO monitoring was considered if consistent hypotension after sufficient fluid resuscitation. Hemodynamic parameters mean arterial pressure （MAP）, central venous pressure （CVP）, cardiac index （CI）, systemic venous resistance index （SVRI）, global end diastolic volume index （GEDVI）, extravascular lung water index （EVLWI）, cardiac function index （CFI）, global ejection fraction （GEF）, LVSWI and LCWI were collected on admission and repeated every 8 hrs within the first 24 hrs. All patients were divided into surviving group （n = 14） and non-surviving group （n = 8） accord- ing to the outcome. Results There were no differences of the hemodynamic data between the two groups at baseline. The parameters including CI, CFI, GEF, LVSWI as well as LCWI were statistically elevated during the first 24 hrs in survivors （P 〈 0.05）, while no significant changes were found in nonsurviving group. Besides, both LVSWI and LCWI positively correlated with CI, CFI and GEF respectively （P 〈 0.01 ）. The decreased LVSWI and LCWI were found in both groups at baseline （P 〉 0.05）, and both elevated in surviving group within 24 hrs, while consistent decreased LVSWI and LCWI in non-survivors （P 〈 0.05）. Conclusion Decreased LVSWI and LCWI reveal that left ventricular dysfunction during fluid resuscitation in patients with septic shock and the sustained low value for LVSWI and LCWI indicate poor prognosis. To strengthen left ventricular performance under the guidance of PiCCO might improve the prognosis.