脓毒症患者左心室功能改变及其临床意义探讨

Discussing about the Characters of Left Ventricular Function and Their Significance in Septic Patients

目的探讨脓毒症患者左心室功能改变特征及其临床意义。方法采用前瞻性研究方法,以84例脓毒症患者为研究对象,20例健康查体者为对照组,脓毒症患者入院后行动态超声心动图检查,并测定血清IL-6和cTnT浓度,同时记录临床资料及临床转归。对照组测定血清IL-6和cTnT浓度。结果根据超声心动图检查结果将脓毒症患者左心室功能的改变分为3种类型:Ⅰ型(51例),表现:LVEDD正常,LVEF正常,E/A减低。Ⅱ型(18例),表现:LVEDD扩大,LVEF正常,E/A减低。Ⅲ型(15例),表现:LVEDD扩大,LVEF减低,E/A减低。三型患者性别、年龄、感染部位及病原体类别之间差别无统计学意义(P>0.05)。脓毒症患者IL-6浓度高于对照组(P<0.01),Ⅲ型患者IL-6和cTnT浓度高于Ⅰ、Ⅱ型(P<0.05);Ⅲ型患者休克、MODS发生率高于Ⅰ、Ⅱ型(P<0.05);病死率:Ⅲ型(73.33%)>Ⅰ型(21.57%)>Ⅱ型(0)(P<0.01)。结论脓毒症患者普遍存在左心室舒张功能减低,部分同时合并左心室收缩功能减低;IL-6和cTnT参与了左心室功能不全的发生;左心室收缩功能减低者预后差;左心室扩张不伴收缩功能减低者预后较好。

Objective To investigate the various changes of left ventricular function and their clinical significance in septic patients.Method A prospective observational study was conducted,in which 84 patients with sepsis and 20 healthy volunteers were enrolled as patient group and control group respectively.For septic patients,serial echocardiography was performed after admitting.Serum level of IL-6 and cTnT were measured within 24 hours,the same as control group.Clinical information and prognosis of each patient were recorded.Results Three types of the left ventricular function were shown：51 patients with normal LVEDD,normal LVEF and decreased E/A（typeⅠ）;18 patients with enlarged LVEDD,normal LVEF and decreased E/A（typeⅡ）;15 patients with enlarged LVEDD,decreased LVEF and decreased E/A（type Ⅲ）.No significantly differences were found for patients＇age,gender,underlying disease,infected source and the kind of pathogeny among the three types.Serum level of IL-6 was significantly higher in patient group than in control group.In patient group,serum level of IL-6 and cTnT were significantly higher in type Ⅲ than typeⅠand typeⅡ.In type Ⅲ,the incidence of shock and MODS were significantly higher than the other two patient groups（P0.05）.Mortality were significant different in the rank order of typeⅡ（0）typeⅠ（21.57%）type Ⅲ（73.33%）（P0.01）.Conclusion Most septic patients show impairment in left ventricular diastolic function,part of them accompanied with left ventricular systolic dysfunction.IL-6 and cTnT contribute to left ventricular dysfunction.Patients with decreased left ventricular contractility show poor prognosis.Dilatation of left ventricular without systolic dysfunction may be a benign factor for outcome.