关键词: 创伤失血性休克； 心室-动脉耦联； 持续心输出量监测

Abstract: Objective To explore the impact of ventricular arterial coupling on the prognosis of patients with traumatic hemorrhagic shock(HTS).Methods 60 HTS patients who were hospitalized in the emergency and critical care departments of Nanjing Drum Tower Hospital Group Suqian Hospital from January 2020 to December 2022 were included.They were divided into survival group(n=30) and death group(n=30) based on their prognosis.The acute physiological and chronic health score Ⅱ(APACHE Ⅱ),sequential organ failure(SOFA) score,lactate(Lac),and central venous oxygen saturation(ScvO₂) of the two groups of patients were monitored,respectively,Compare the central venous pressure(CVP),cardiac index(CI),stroke volume index(SVI),global end diastolic volume index(GEDVI),systemic vascular resistance index(SVRI),and mean arterial pressure(MAP) of two groups of patients under continuous monitoring of pulse indicator cardiac output(PiCCO),and calculate the left ventricular arterial coupling(VAC) index.Results The Lac levels in the survival group and death group were (2.31±1.29)mmol/L and (3.98 ±1.01)mmol/L,respectively,with statistical significance(P<0.05);The ScvO₂ values for the survival group and death group were (62.69±5.73)% and (60.3±5.35)%,respectively,with no significant statistical difference(P>0.05);The survival group showed a statistically significant decrease in APACHE Ⅱ score[(18.57±2.23)points vs (23.00±3.15)points] and SOFA score[(9.40±2.15)points vs (14.07±2.26)points] compared to the death group(P<0.05),with an increase in CI[(2.97±0.20)L/(min·m² )vs (2.73±0.27)L/(min·m²)],an increase in SVI[(50.11±4.31)ml/m² vs (46.53±3.49)ml/m²],and a decrease in VAC[(1.34±0.19) vs (1.69±0.28)],and a statistically significant difference(P<0.05),However,there was no significant statistical difference in CVP[(9.19±1.20)mmHg vs (9.35±1.53)mmHg)],GEDVI[(715.73±101.72)ml/m² vs (717.93±89.07)ml/m²],SVRI[(2 061.55±701.23)dyn·sec·cm^-5·m^-2 vs (2 164.31±732.16)dyn·sec·cm^-5·m^-2],and MAP[(92.21±10.81)mmHg vs (89.19±17.33)mmHg] between the survival and death groups(P>0.05);Logistic regression analysis showed that VAC(OR=1.41),Lac(OR=1.36),APACHE Ⅱ score(OR=1.25),SOFA score(OR=1.21),CI(OR=1.31),and SVI(OR=1.20) were risk factors for mortality in patients with traumatic hemorrhagic shock(P<0.05).Conclusion VAC has a certain impact on the prognosis of patients with traumatic hemorrhagic shock.

Key words: traumatic hemorrhagic shock; left ventricular arterial coupling; continuous cardiac output monitoring