摘要
目的分析脓毒症心肌功能障碍(SIMD)的危险因素及临床特征,为SIMD的诊治及预防提供依据.方法回顾性分析2020年1月至2022年12月于成都市中西医结合医院/成都市第一人民医院重症医学科收治的284例脓毒症患者(年龄≥18岁)的临床资料,包括性别、年龄、基础性疾病、平均动脉压(MAP)、心率(HR)、实验室检查结果、疾病严重程度评分、机械通气比例、使用血管活性药物和肾替代治疗的比例,以及ICU住院时间和28d病死率等.根据是否发生心肌功能障碍将患者分为SIMD组和非SIMD组,分析两组患者的临床特征,采用单因素和多因素Logistic回归分析筛选出影响患者发生SIMD的危险因素,并绘制受试者工作特征曲线(ROC曲线),分析各危险因素对脓毒症患者发生SIMD的预测价值.结果共纳入284例患者,SIMD组136例(47.89%),非SIMD组148例(52.11%).与非SIMD组比较,SIMD组患者的年龄、N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、入住ICU时血乳酸(Lac)水平、使用血管活性药物比例、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分及序贯器官衰竭评分(SOFA)均明显升高[年龄(岁):75.92±2.35比55.02±1.68,NT-proBNP(ng/L):3037.00±544.50比2493.92±630.21,cTnI(μg/L):0.12±0.07比0.06±0.03,入住ICU时血Lac(mmol/L):4.46±1.21比2.98±1.02,血管活性药物使用比例:40.44%(55/136)比21.62%(32/148),APACHEⅡ评分(分):24.25±1.02比20.95±0.85,SOFA评分(分):7.41±4.69比6.21±2.81,均P<0.05],而SIMD组24 h Lac清除率明显降低[(13.80±7.01)%比(25.41±8.90)%,P<0.05].多因素Logistic回归分析显示:年龄≥75岁、24 h Lac清除率<13.80%、NT-proBNP≥3000 ng/L是发生SIMD的独立危险因素[优势比(OR)和95%可信区间(95%CI)分别为5.990(2.143~16.742)、0.348(0.155~0.786)、2.708(1.093~6.711),P值分别为0.001、0.011、0.031].ROC曲线分析显示:年龄、24 h Lac清除率和NT-proBNP水平对SIMD的发生均有预测价值[ROC曲线下面积(AUC)分别为0.637、0.811、0.743,95%CI分别为0.573~0.701、0.761~0.860、0.687~0.800,均P<0.05].结论脓毒症患者SIMD的发病率较高,年龄增大、24 h Lac清除率下降、NT-proBNP增高是患者发生SIMD的独立危险因素,应加以重视.
Objective To investigate clinical characteristics and the risk factors of sepsis-induced myocardial dysfunction(SIMD),and to provide evidence for the diagnosis,treatment and prevention of SIMD.Methods The clinical data of 284 patients with sepsis(≥18 years old)admitted to the department of critical care medicine of Chengdu Integrated Traditional Chinese Medicine&Western Medicine Hospital/Chengdu First People's Hospital from January 2020 to December 2022 were retrospectively analyzed.This includes gender,age,chronic underlying diseases,the mean arterial pressure(MAP),heart rate(HR),laboratory test results,disease severity score,the proportion of requiring mechanical ventilation,vasoactive drugs treatment and renal replacement therapy,length of intensive care medicine(ICU)stay and the 28-day mortality.Patients were divided into SIMD group and non-SIMD group according to the occurrence of SIMD,allowing for an analysis of the clinical characteristics of two groups of patients.Univariate and multivariate Logistic regression analyses were used to identify the risk factors of SIMD,and receiver operator characteristic curve(ROC curve)were plotted to analyze the predictive value of each risk factor for the occurrence of SIMD.Results A total of 284 septic patients were included,including 136 cases(47.89%)in the SIMD group and 148 cases(52.11%)in the non-SIMD group.Compared with the non-SIMD group,the levels of age,N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac tropomin I(cTnI),lactic acid(Lac)at admission to ICU,the proportion of vasoactive drugs treatment,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)in the SIMD group were significantly higher than those in the non-SIMD group[age(years):75.92±2.35 vs.55.02±1.68,NT-proBNP(ng/L):3037.00±544.50 vs.2493.92±630.21,cTnI(μg/L):0.12±0.07 vs.0.06±0.03,Lac in ICU(mmol/L):4.46±1.21 vs.2.98±1.02,the proportion of vasoactive drugs treatment:40.44%(55/136)vs.21.62%(32/148),APACHEⅡscore:24.25±1.02 vs.20.95±0.85,SOFA score:7.41±4.69 vs.6.21±2.81,all P<0.05],but the 24-hour Lac clearance rate of the SIMD group was significantly lower than that of the non-SIMD group[(13.80±7.01)%vs.(25.41±8.90)%,P<0.05].Multivariate Logistic regression analysis showed that age≥75 years,24-hour Lac clearance rate and NT-proBNP≥3000 ng/L were the independent factors of SIMD in patients with sepsis[odds ratio(OR)and 95%confidence interval(95%CI)were 5.990(2.143-16.742),0.348(0.155-0.786)and 2.708(1.093-6.711),P values were 0.001,0.011 and 0.031].ROC curve analysis showed that age,24-hour Lac clearance rate,NT-proBNP had predictive value for the development of SIMD[area under the curve(AUC)were 0.637,0.811,0.743,95%CI were 0.573-0.701,0.761-0.860,0.687-0.800,all P<0.05].Conclusions SIMD occurs more frequently in patients with sepsis.Increased age,elevated NT-proBNP,and reduced 24-hour Lac clearance rate are independent risk factors of SIMD,warranting clinical attention.
作者
周智恩
严善秀
卢萍
姚娟
包牧龙
侯娟
简漪沫
马瑶
Zhou Zhi'en;Yan Shanxiu;Lu Ping;Yao Juan;Bao Mulong;Hou Juan;Jian Yimo;Ma Yao(Department of Critical Care Medicine,Chengdu Integrated Traditional Chinese Medicine&Western Medicine Hospital Chengdu First People's Hospital,Chengdu 610017,Sichuan,China;The Second Department of Geriatrics,Chengdu Gulian Tianchen Geriatric Hospital,Chengdu 611731,Sichuan,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
2024年第4期428-432,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
四川省中医药管理局中医药科研专项(2023MS017)
四川省成都市首批中医临床优秀人才项目(20220509)
成都中医药大学“杏林学者”学科人才科研提升计划(YYZX2022046)。
作者简介
通信作者:周智恩,Email:826050368@qq.com。
