摘要
目的:研究脓毒症新发心律失常的发病率及危险因素。方法:回顾性分析辽宁省人民医院2018-01—2019-10期间收治的脓毒症患者315例。根据是否出现新发心律失常将患者分为新发心律失常组和非新发心律失常组,比较两组患者的临床资料,采用二元logistic回归分析筛选脓毒症新发心律失常的独立危险因素。结果:315例脓毒症患者中91例出现新发心律失常(28.89%)。新发心律失常组与非新发心律失常组患者间性别、既往病史[慢性阻塞性肺疾病(COPD)、高血压、糖尿病、缺血性心脏病、心律失常、心力衰竭、肾脏疾病、脑血管病、恶性肿瘤]比较均差异无统计学意义(P>0.05),急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分比较差异有统计学意义(P=0.00),两组患者间年龄(P=0.00)、器官功能障碍中的呼吸衰竭(P=0.00)、心力衰竭(P=0.02)、代谢紊乱(P=0.00)、急性肾损伤(P=0.03)、凝血功能障碍(P=0.03)及高敏肌钙蛋白(hs-cTnT)(P=0.00)差异有统计学意义,肝脏功能障碍差异无统计学意义(P=0.16),机械通气(P=0.00)、儿茶酚胺药物使用(P=0.00)、肾脏替代治疗(CRRT)(P=0.04)差异均有统计学意义。二元Logistic回归分析显示年龄(OR=1.00,95%CI:0.98~1.03)、hs-cTnT(OR=1.32,95%CI:1.18~1.47)呼吸衰竭(OR=1.53,95%CI:0.79~2.98)、心力衰竭(OR=1.27,95%CI:0.54~2.97)、代谢紊乱(OR=2.24,95%CI:1.14~4.38)、急性肾损伤(OR=1.11,95%CI:0.51~2.42)、凝血功能障碍(OR=1.61,95%CI:0.76~3.41)机械通气(OR=2.81,95%CI:0.16~48.27)、儿茶酚胺药物使用(OR=1.87,95%CI:1.01~3.47)是脓毒症新发心律失常的独立危险因素。结论:脓毒症新发心律失常发病率较高,年龄、hs-cTnT、呼吸衰竭、心力衰竭、代谢紊乱、急性肾损伤、凝血功能障碍、机械通气、儿茶酚胺药物使用是脓毒症新发心律失常的独立危险因素,其中机械通气、儿茶酚胺药物使用、代谢紊乱是脓毒症新发心律失常的强独立危险因素。
Objective: To investigate the incidence and risk factors of new-onset arrhythmia in patients with sepsis. Method: A retrospectively study was conducted. Total 315 patients with sepsis admitted to the People’s Hospital of Liaoning Province were selected during January 2018 to October 2019. Patients were divided into new-onset arrhythmia group and non-new-onset arrhythmia group according to whether or not they had new-onset arrhythmia. The baseline data and clinical outcomes were compared between the two groups. Binary logistic regression analysis was performed to find the independent risk factors of new-onset arrhythmia in patients with sepsis. Result: Among total 315 patients, 91(28.89%) developed new-onset arrhythmia. There was no statistical difference in gender and medical history such as chronic obstructive pulmonary disease(COPD), hypertension, diabetes, ischemic heart disease, arrhythmia, heart failure, kidney disease, cerebrovascular disease and malignant tumors between the sepsis new-onset arrhythmia group and non-new-onset arrhythmia group(P>0.05). APACHEⅡscore(P=0.00), age(P=0.00), respiratory failure(P=0.00), heart failure(P=0.02), metabolic disorder(P=0.00), acute kidney injury(P=0.03), blood coagulation dysfunction(P=0.03), highly sensitive cardiac troponin(hs-cTnT)(P=0.00), mechanical ventilation(P=0.00), catecholamine drug(P=0.00) and continuous renal replacement therapy(CRRT)(P=0.04) were significantly different between two groups. There was no difference in hepatosis between two groups. Binary logistic regression analysis showed that age(OR=1.00, 95%CI: 0.98-1.03), hs-cTnT(OR=1.32, 95%CI: 1.18-1.47), respiratory failure(OR=1.53, 95%CI: 0.79-2.98), heart failure(OR=1.27, 95%CI: 0.54-2.97), metabolic disorder(OR=2.24, 95%CI: 1.14-4.38), acute kidney injury(OR=1.11, 95%CI: 0.51-2.42), blood coagulation dysfunction(OR=1.61, 95%CI: 0.76-3.41), mechanical ventilation(OR=2.81, 95%CI: 0.16-48.27), catecholamine drug(OR=1.87, 95%CI: 1.01-3.47) were independent risk factors of new-onset arrhythmia in patients with sepsis. Conclusion: New-onset arrhythmia has a relatively high incidence in patients with sepsis. Age, hs-cTnT, respiratory failure, heart failure, metabolic disorder, acute kidney injury, blood coagulation dysfunction, mechanical ventilation and catecholamine drug were independent risk factors of new-onset arrhythmia in patients with sepsis. Among them mechanical ventilation, catecholamine drug and metabolic disorder were strong independent risk factors of new-onset arrhythmia in patients with sepsis.
作者
周淑清
沈涛
王钢
杨林
葛百平
赵瑜
刘文书
ZHOU Shuqing;SHEN Tao;WANG Gang;YANG Lin;GE Baiping;ZHAO Yu;LIU Wenshu(Department of Emergency,the People’s Hospital of Liaoning Province,Shenyang,110016,China;Department of Emergency,the Hospital of PLA Northern Theater Command Air Force)
出处
《临床急诊杂志》
CAS
2020年第2期135-139,共5页
Journal of Clinical Emergency
基金
辽宁省科学技术计划项目(No:2019-ZD-0416).
作者简介
通信作者:王钢,E-mail:Wg5385@sohu.com
