摘要
目的:分析脓毒症心肌病(SICM)的危险因素。方法:选择210例脓毒症患者进行前瞻性分析,根据是否发生SICM分为SICM组(45例)和非SICM组(165例)。比较2组患者的一般资料、急性生理与慢性健康评估(APACHE Ⅱ)评分、序贯脓毒症相关性器官功能衰竭(SOFA)评分、血液学指标以及治疗的差异。应用多因素Logistic回归模型分析脓毒症患者发生SICM的独立危险因素,并比较2组患者预后的差异。结果:SICM组患者的平均年龄、糖尿病、高血压、心力衰竭和冠心病比例明显高于非SICM组(均P <0. 05),2组性别比例、体重指数(BMI)、感染部位以及慢性阻塞性肺疾病、慢性肾脏病比例比较,差异无统计学意义(均P> 0. 05)。SICM组的APACHE Ⅱ评分、SOFA评分,血清降钙素原(PCT)、白介素6(IL-6)、心肌肌钙蛋白(c Tn I)、N末端B型脑钠肽前体(NT-proBNP)水平及大量升压药应用比例明显高于非SICM组(均P <0. 05)。2组患者血肌酐(SCr)、血小板(PLT)、白细胞(WBC)、C反应蛋白(CRP)、乳酸水平以及连续肾脏替代治疗(CRRT)和输血比例比较,差异无统计学意义(均P> 0. 05)。多因素Logistic回归分析显示,年龄、冠心病以及血清IL-6、c Tn I、NT-proBNP水平是脓毒症患者发生SICM的独立危险因素(均P <0. 05)。SICM组和非SICM组患者28 d病死率分别为42. 22%(19/45)和27. 27%(45/165),SICM组患者的死亡风险明显高于非SICM组患者[HR=1. 834,95%CI(1. 022,3. 437),P=0. 023]。结论:年龄、冠心病以及血清IL-6、c Tn I、NT-proBNP水平是脓毒症患者发生SICM的独立危险因素,SICM患者的死亡风险明显高于非SICM患者。
Objective:To analyze the risk factors of sepsis-induced cardiomyopathy(SICM).Methods:210 patients with sepsis who came to hospital for diagnosis were prospectively analyzed,and they were divided into SICM group(45 cases)and non-SICM group(165 cases)according to whether SICM occurred.The general data,acute physiology and chronic health assessment(APACHE II)score,sequential organ failure assessment(SOFA),hematological indices and treatment differences were compared between the two groups.Multivariate logistic regression model was used to analyze the independent risk factors for SICM in sepsis patients and to compare the difference in prognosis between SICM patients and non-SICM patients.Results:The average age,and the proportions of diabetes mellitus,hypertension,heart failure and coronary heart disease in SICM group were significantly increased as compared with those in non-SICM group(all P<0.05).There were no significant differences in sex ratio,body mass index(BMI),infection site,proportions of chronic obstructive pulmonary disease and chronic kidney disease between the two groups(all P>0.05).APACHE II score,SOFA score,serum PCT,IL-6,cTnI,NT-proBNP levels and the proportion of large amount of pressor drugs use in SICM group were significantly higher than those in non-SICM group(all P<0.05).There were no significant differences in SCr,PLT,WBC,CRP,lactic acid level,CRRT and blood transfusion ratio between the two groups(all P>0.05).Multivariate logistic regression analysis showed that age,coronary heart disease and serum levels of IL-6,cTnI,NT-proBNP were independent risk factors for SICM in sepsis patients(all P<0.05).The 28-day mortality rate of SICM group and non-SICM group patients was respectively 42.22%(19/45)and 27.27%(45/165).The risk of death in SICM group patients was significantly greater than that in non-SICM group patients[HR=1.834,95%CI(1.022,3.437),P=0.023].Conclusion:Age,coronary heart disease and serum IL-6,cTnI,NT-proBNP levels were independent risk factors for SICM in sepsis patients,and the risk of death in SICM patients was significantly greater than that in non-SICM patients.
作者
贾依娜尔
董岩
杨立新
JIA Yi-na-er;DONG Yan;YANG Li-xin(The Third Clinical Medical College of Xinjiang Medical University Affiliated Cancer Hospital,Urumqi 830011,China)
出处
《内科急危重症杂志》
2020年第2期122-125,共4页
Journal of Critical Care In Internal Medicine
基金
新疆医科大学科研创新基金项目(No:XYDCX201675)
作者简介
通信作者:杨立新,E-mail:km2001xj@163.com
