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目的:比较2016年版与2009年版指南诊断脓毒症患者左室舒张功能不全的差异性。方法:采用单中心前瞻性队列研究，以2016年10月至2019年1月在重症监护病房（ICU）住院的脓毒症或脓毒性休克患者为研究对象。入住ICU后24 h和第3天经胸行超声心动图检查，根据2009年和2016年指南分别对左室舒张功能不全进行分级。同时记录入ICU 24 h内患者的基线资料，入ICU后首次血气分析、生化指标，以及住ICU期间感染部位、肾上腺素和多巴酚丁胺使用情况、去甲肾上腺素最大使用剂量、氢化可的松、有创机械通气和肾脏替代治疗情况。采用两独立样本秩和检验比较两版指南诊断左室舒张功能不全的差异。结果:共筛查脓毒症或脓毒性休克患者196例，排除86例，最终110例患者纳入分析。入ICU首次超声检查中位时间为17 h。基线资料分析中不同等级舒张功能的患者间，仅年龄差异有统计学意义，其他观察指标均差异无统计学意义。根据2016年版指南，入ICU 24 h内，110例患者中43例(39%)有舒张功能不全，另有30例（27%）为舒张功能不全不确定；根据2009年指南，有40例(36%)存在舒张功能不全，而有58例(53%)存在舒张功能不全不确定。两版指南对不同等级左室舒张功能不全的诊断差异有统计学意义（n Z=4.92，n P<0.01）。在入ICU第3天，根据2016年版指南，52例(47%)被诊断为舒张功能不全，18例(18%)存在舒张功能不全不确定；根据2009年的指南，其中50例(46%)被诊断为舒张功能不全，45例(41%)为舒张功能不全不确定。两版本指南诊断差异性较大(n Z=4.60，n P50%）的患者进行亚组分析显示，入ICU首个24 h和第3天，两版指南对收缩功能正常患者左室舒张功能不全的诊断差异均较大（分别n Z=4.34，n P<0.01和n Z=5.71，n P<0.01）。n 结论:与2009年版指南相比，2016年版指南对脓毒症或脓毒性休克患者左室舒张功能不全的检出率更高，但所使用的诊断指标在危重患者中的应用仍然存在不足。“,”Objective:To assess the differences of the 2016 and 2009 edtion guidelines on diastolic dysfunction in sepsis patients.Methods:A single-center, prospective study was conducted. The relevant information of sepsis patients in Intensive Care Unit (ICU) were analyzed from October 2016 to January 2019. Patients’ transthoracic echocardiography at the first 24 h and 3rd day of their admission and left ventricular diastolic dysfunction were stratified according to the 2009 and 2016 edition guidelines. Patients’ characteristics, arterial blood gas analysis, and blood biochemical indexes were recorded at the first 24 h of the ICU admission. Additionally, the following information were retrieved during ICU stay: site of infection, frequency of adrenaline and dobutamine, maximal dose of norepinephrine, use of hydrocortisone, invasive mechanical ventilation and renal replacement therapy. The rank-sum test of two independent samples was used to compare the differences in the diagnosis of left ventricular diastolic dysfunction.Results:A total of 196 patients with sepsis or septic shock were screened, and 86 patients were excluded. Finally, clinical data of 110 patients were included in the analysis.The median time of the first ultrasound examination in ICU was 17 h. Among the patients with different diastolic function severity in baseline data analysis, only age was significantly different. According to the 2016 edition guidelines, 43 (39%) of 110 patients had diastolic dysfunction and another 30 (27%) had indeterminate diastolic dysfunction within 24 h of ICU admission. According to the 2009 edition guidelines, 40 (36%) patients had diastolic dysfunction and 58 (53%) patients had indeterminate diastolic dysfunction. The diagnosis of left ventricular diastolic dysfunction of different grades was significantly different between the 2016 and 2009 edition guidelines (n Z=4.92, n P<0.01). According to the 2016 edition guidelines at the 3rd day of ICU admission, 52 (47%) patients were diagnosed with diastolic dysfunction and 18 (18%) were diagnosed with indeterminate diastolic dysfunction; According to the 2009 edition guidelines, 50 (46%) of these patients were diagnosed with diastolic dysfunction and 45 (41%) had indeterminate diastolic function. Similarly, there was a large difference in diagnosis (n Z=4.60, n P 50%) showed that the diagnosis of left ventricular diastolic dysfunction were significantly different at the first 24 h and the 3rd day of ICU admission ( n Z=4.34, n P<0.01 and n Z=5.71, n P<0.01).n Conclusions:The 2016 edition guidelines identify a significantly higher incidence of dysfunction in patients with severe sepsis and septic shock compared to the 2009 edition guidelines. Although the 2016 edition guidelines seem to be an improvement, issues remain with the application of guidelines using traditional measures of diastolic dysfunction in this cohort.