脓毒症心肌抑制对脓毒症患者心功能及预后的影响研究

Study on cardiac function and prognosis of sepsis patients with sepsis myocardial depression

目的探讨脓毒症心肌抑制对脓毒症患者心功能及预后的影响研究。方法选取我院2015年1月~2016年12月收治的132例脓毒症患者为研究对象,对所有患者进行前瞻性分析,根据患者进入ICU时左室射血分数(LVEF)分为心肌抑制组56例(LVEF<0.5)和无心肌抑制组76例(LVEF≥0.5)。两组患者进入ICU第1、3、7天对心功能评价和血流动力学指标检测,并记录28d预后情况。结果入ICU第1天,心肌抑制组中心静脉压(CVP)、左室舒张末期内径(LVEDD),明显高于无心肌抑制组,差异有统计学意义(P<0.05),心脏指数(CI)、肺血管通透性指数(PVPI)间比较差异无统计学意义(P>0.05);入ICU第3天,两组患者以上指标均无统计学意义(P>0.05);入ICU第7天,两组CVP、LVEDD差异均无统计学意义(P>0.05),心肌抑制组CI、PVPI明显低于无心肌抑制组,差异有统计学意义(P<0.05)。28d后心肌抑制组和无心肌抑制组生存率分别为75.00%、82.89%,差异无统计学意义(P>0.05)。结论脓毒症心肌抑制对心肌损伤具有可逆性,对心排血量和其他器官损坏影响较小,可降低左室收缩功能和扩大心室,对28d的死亡率无明显影响。

Objective The explore the study on cardiac function and prognosis of sepsis patients with sepsis myocardial depression. Methods 132 patients with sepsis from January 2015 to December 2016 were selected as the study subjects,and all patients were prospectively analyzed.According to the left ventricular ejection fraction （LVEF） enter the ICU,all patients were divided into two groups：the myocardial depression group（LVEF 〈 0.5）,counting 56 patients,the non- myocardial depression group（LVEF 〉 0.5）,counting 76 patients.Then,the cardiac function evaluation and hemodynamic index detection of two groups on the first,third,and seventh day in ICU were evaluated,and the prognosis of the twenty- eighth day was recorded. Results In ICU,on the first day,the central venous pressure（CVP）,left ventricular end diastolic diameter（LVEDD） of myocardial depression group were significantly higher than the non-myocardial depression group,the difference was statistically significant（P 〈 0.05）;While,the differences between cardiac index（CI） and pulmonaryvascular permeability index （PVPI） were no statistical significance（P 〉 0.05）,On the third day,there was no difference of CUP,LVEDD,CI,and PVPI;On the seventh day,the differences of index of CUP,LVEDD in two groups were no statistical significance（P 〈 0.05）,the CI,PVPI of myocardial depression group were lower than those of non-myocardial depression group,the difference was statistically significant（P 〈 0.05）.On the twenty-eighth day,the survival rate of group of myocardial depression and non-myocardial depression respectively were 75.00% and 82.89%,there was no statistical significance（P 〉 0.05）. Conclusion Sepsis myocardial inhibition on myocardial damage is reversible,has little influence on cardiac output and other organs damage,can reduce the left ventricular systolic function and expanding ventricle,and had no effect on the death rate of the twenty-eighth day.