探讨急性颅脑疾病患者早期心功能参数的分布状况以及其对预后的影响。

本研究回顾性调查了2009年1月~2014年12月共71位由于急性颅脑疾病而收住北京大学首钢医院重症医学科（ICU）患者的病历资料，所有研究对象于发病6 h内置入PICCO导管监测心功能等血流动力学参数。收集研究对象年龄、性别、APACHE Ⅱ评分、格拉斯哥（GCS）评分、转归等一般资料，以及颅脑疾病的类别、高血压病、冠心病、心功能不全等临床诊断资料；应用PULSION PiCCO plus容量监测仪测定心功能参数包括心功能指数（CFI）、全心射血分数（GEF）、左心室收缩力指数（dPmax）、心指数（CI）和每搏量指数（SVI）。根据患者28天转归情况将患者分为死亡组和存活组。分析急性颅脑疾病患者在发病早期各心功能参数的分布情况。

死亡组和存活组2组GCS评分存在显著性差异P＜0.05（P=0.02）。对2组发病后每天心功能进行分析，结果显示发病后第2天、第3天、第4天和第7天dPmax水平有显著性差异（P分别为0.012、0.016、0.025和0.029），死亡组均高于存活组；同时第3天CI水平和第7天SVI水平有显著差异（P分别为0.013和0.015）死亡组均低于存活组。进一步相关分析显示PICCO测得的心功能参数之间有着较好的相关性，但dPmax与GEF（r=0.02，P=0.750）和SVI（r=-0.02，P=0.622）之间无相关性，同时除了CI与GCS评分（r=-0.07，P=0.133）无相关性外，其余各心功能参数均与GCS评分有较好的相关性，其中CFI和dPmax与GCS评分呈负相关关系。而偏相关分析显示，无论总体患者还是存活组与死亡组患者，其心功能变化与发病天数均无相关性。进一步的生存分析显示第2天CFI、第3天CFI、第2天dPmax、第3天dPmax和第1天的CI对28天生存情况有影响（P分别为0.038、0.019、0.035、0.020和0.019），CFI、CI降低的患者生存率明显降低，以及dPmax正常的患者生存率明显降低。

急性颅脑疾病患者发病后，心功能状态会有所变化，并且与28天存活率有关。

To investigate the clinical significance of cardiac function parameters in intensive care unit (ICU) patients with early stage acute cerebral disease.

Seventy-one patients with acute cerebral disease treated in the ICU from January 2009 to December 2014 were retrospective reviewed. All the patients underwent PICCO catherization to monitor hemodynamic parameters, especially cardiac function parameters, within six hours. Information about age, sex, APACHE Ⅱ score, Glasgow coma scale (GCS) score, and outcome at 28 days was collected. The clinical diagnostic data on the type of cerebral disease, hypertension, coronary heart disease, and heart failure were also collected. Cardiac function parameters were measured with PULSION PiCCO plus, including cardiac function index (CFI), global ejection fraction (GEF), left ventricular contractility index (dpmax), and cardiac index (CI). The patients were divided into either a death group or a survival group according to the outcome at 28 days. Then cardiac function parameters were analyzed in the two groups.

There was a significant difference in GCS score between the two groups (P=0.02). There was a higher dpmax level in the death group on the 2nd, 3rd, 4^th, and 7th day after the onset of the disease (P=0.012, 0.016, 0.025, and 0.029, respectively), but there was a lower CI on the 3rd day and SVI level on the 7th day in the death group after the onset of the disease (P=0.013 and 0.015, respectively). Further correlation analysis showed that there were significant correlations between most of the cardiac function parameters measured by PiCCO, though there was no significant correlation between dpmax and GEF (r=0.02, P= 0.75) or SVI (r=-0.02, P=0.622). Except CI (r=-0.07, P=0.133), other cardiac function parameters were all significantly correlated with GCS score. Partial correlation analysis showed that there was no correlation between the cardiac function parameters and the number of days of onset in both the overall patients and the patients in the survival group or the death group. Further survival analysis showed that CFI on the 2nd day, CFI on the 3rd day, dpmax on the 2nd day, dpmax on the 3rd day, and CI on the 1st day had significant effects on 28-day survival (P=0.038, 0.019, 0.035, 0.020, and 0.019, respectively). The survival rate of patients with reduced CFI and CI and patients with normal dpmax decreased significantly.

After the onset of acute cerebral disease, there are cardiac function changes, which is related to the 28-day survival rate.