ICU严重脓毒血症患者合并心肌损伤的相关因素分析及护理策略

Risk factors of myocardial injury in ICU severe sepsis patients and related nursing strategies

目的探讨ICU严重脓毒血症患者合并心肌损伤的危险因素分析及相关护理策略。方法选取2013年2月-2017年2月医院ICU收治的123例严重脓毒血症患者为研究对象,住院期间发生心肌损伤患者45例,收集并比较患者入院后的临床资料和实验室检查,利用多因素Logistic回归分析此类患者心肌损伤发生的危险因素。结果发生心肌损伤患者45例,发生率为36.59%;多因素Logistic回归分析结果显示,急性生理与慢性健康评分(APACHEⅡ)、N末端脑钠肽前体(NT-proBNP)、C-反应蛋白(CRP)、降钙素原(PCT)、血糖是严重脓毒血症患者发生心肌损伤的独立危险因素,而平均动脉压(MAP)是保护性因素(P<0.05)。结论严重脓毒血症患者发生心肌损伤受到诸多因素影响,对于MAP较低、APACHEⅡ评分较高,机体高水平CRP、NT-proBNP、PCT、血糖的患者应当视为高危患者,应当采用针对性的护理干预措施,以改善患者预后。

OBJECTIVE To investigate the risk factor of myocardial injury in ICU severe sepsis patients and related nursing strategies.METHODS A total of 123 cases of patients with severe sepsis in ICU from Feb.2013 to Feb.2017 were selected as research subjects.There were 45 patients occurred myocardial injury during hospitalization.General clinical data and laboratory examinations were collected and compared,risk factors for patients with myocardial injury were analyzed by multivariable Logistic regression analysis.RESULTS There were 45 patients occurred myocardial injury during hospitalization,and the incidence of myocardial injury was 36.59%.Multivariable Logistic regression analysis showed that,chronic health evaluation（APACHEⅡ）score,N-terminal pro-brain natriuretic peptide（NT-proBNP）,C-reactive protein（CRP）,procalcitonin（PCT）,and blood sugar were independent risk factors for myocardial damage in severe sepsis patients,and mean arterial pressure（MAP）was the protective factor（P〈0.05）.CONCLUSION Myocardial injury in patients with severe sepsis are affected by many factors,and patients with low MAP,high APACHEⅡscore,and high levels of CRP,NT-proBNP,PCT,and blood sugar are considered as high-risk patients.Targeted nursing intervention measures should be adopted to improve the prognosis of patients.