Abstract
Aim: to study characteristics of the central hemodynamics (CHD) in patients with severe abdominal sepsis with different outcomes of the disease. Materials and Methods. 18 patients with abdominal sepsis, aged 50.2±3, with the APACHE II and SOFA severity scoring of 13.7±0.8 and 8.4±0.5, respectively, were enrolled in the retrospective study. The CHD was studied using the transpulmonary thermodilution. The following groups were identified: Group 1 (deceased, n=9) and Group 2 (survivors, n=9). The groups did not differ (P>0.05) in age, sex, and the severity of the condition at admission to the ICU. The significance of differences was assessed using the t-test and the chi-squared test. The prognostic value of the parameters was studied using the ROC analysis. Results. On Day 1, the intergroup differences included the average blood pressure (BPav) (85.3±3.3 and 101.6±4.6 mmHg, respectively (P 7 (sensitivity: 88.9%, specificity: 88.9%) was the most important predictor of the lethal outcome (areas under ROC curves: 0.957—0.994; P<0.05). Conclusion: during the first five days of the intensive treatment of severe sepsis in patients with unfavorable prognosis, a moderate decrease in the cardiac power index and overall cardiac systolic function was registered. The prognostic significance of such parameters as CPI and GEF may become obvious within the first 3 days of the intensive treatment.
Highlights
Улучшение результатов интенсивного лече ния сепсиса является одной из наиболее актуаль ных задач современной реаниматологии [1]
18 patients with abdominal sepsis (9 men and 9 women) aged 26—71 (50.2±3) years were enrolled in the study
The study was a retrospective one; the basic terms for the selection of case history records of patients with abdominal sepsis for the retrospective analysis was the presence of a written informed consent for the use of inva sive monitoring and treatment measures, the use of transpulmonary thermodilution from Day 1 of the intensive care unit (ICU) stay until Day 7 of the intensive treatment with the mandatory presence of monitoring data on Days 1, 3, 5, and 7
Summary
Улучшение результатов интенсивного лече ния сепсиса является одной из наиболее актуаль ных задач современной реаниматологии [1]. Посвященных расстройствам центральной гемодинамики (ЦГД) при тяжелых инфекционных заболеваниях, неред ко осложняющихся сепсисом [2, 3]. В этой связи, особенности состояния ЦГД у боль ных тяжелым сепсисом привлекают пристальное внимание исследователей [6]. С одной стороны, указывают, что мониторинг ЦГД необходим для комплексной оценки состояния больного, уточне ния возможных причин нарушений кровообраще ния и оценки эффективности лечебных мер [7, 8], с другой — остается неясным, какие именно пока затели могут явиться предикторами неблагопри ятного исхода [9, 10]. Ведется дискуссия о показа телях ЦГД, которые могут влиять на выбор оптимальной лечебной тактики [6, 11]
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