入院时心力衰竭对感染性休克患者预后的影响

A prognosis analysis for septic shock combined with heart failure on admission

目的探讨入院时心力衰竭对感染性休克患者预后的影响。方法采取前瞻性研究方法选取EICU和ICU收治的既往有器质性心脏病，且人院时合并心力衰竭的感染性休克患者24例为研究组，同期收治的无器质性心脏病、不伴心力衰竭的感染性休克患者24例为对照组。研究器质性心脏病伴心力衰竭的感染性休克患者住院28d的生存情况。结果研究组容量有反应性的患者明显少于对照组（P〈0．01）；研究组6h乳酸清除率低于对照组（P〈0．01）；研究组应用多巴酚丁胺的患者多于对照组（P〈0．01）；研究组需行CRRT的患者比例高于对照组（P〈0．05）；研究组的有创机械通气时间和ICU住院时间长于对照组（P〈0．01）。Kaplan-Meier生存分析结果显示，研究组的28d累积住院病死率高于对照组（P〈0．05）。多变量Cox比例风险模型分析结果显示，在校正血浆B型利钠肽原（BNP）、射血分数（EF）、血乳酸（Lacticacid，Lac）、乳酸清除率（LC）、容量反应性、SOFA评分后，BNP（HR=1．002，95％CI1．000～1．002，P〈0．05），LC（HR=1．189，95％CI1．010～1．399，P〈0．05），容量反应性（HR=0．228，95％C10．061～0．852，P〈0．05）是感染性休克死亡的独立预测因素。结论器质性心脏病且入院时伴有心力衰竭的感染性休克患者，容量反应性低，28d累积住院病死率高。BNP、LC、容量反应性是感染性休克死亡的独立预测因素。

Objective To investigate the prognostic value for the in - hospital patients with septic shock and heart failure （HF） on admission. Methods The study was performed with a prospective, randomized method. 24 septic shock and structural heart disease （SHD） with HF patients in EICU and ICU were included in the study group, the corresponding period, 24 septic shock patients without SHD and HF were included in the control group. Association between HF on admission and 28 days in - hospital mortality of septic shock was analyzed. Results Fluid responders in study group were significantly less than those in control group （P 〈 0.01 ）. 6h- lactate clearance rate in study group was significantly lower than that in control group （ P 〈 0.01 ）. The patients of using dobutamine in study group were significantly more than the patients in control group （ P 〈 O. O1 ）. The patients of using continuous renal replacement therapy （CRRT） were significantly more than the patients in control group （P 〈 O. 05 ）. The duration of invasive mechanical ventilation and ICU stay were significantly longer in study group than those in control group （ P 〈 0.01 ）. Kaplan - Meier survival analysis showed that patients in study group had significant higher in - hospital 28 days mortality compared with control group （P 〈 0.05 ）. Muhiple Cox proportional hazard analysis showed that BNP （HR = 1. 002, 95% C1 1. 000 -1. 002, P 〈 0. 05）, LC （HR = 1. 189, 95% CI 1. 010 N 1. 399, P 〈 0. 05）, fluid responsiveness （ HR = O. 228, 95 % CI O. 061 - O. 852, P 〈 O. 05 ） remained as independent predictors of death for septic shock with HF. Conclusion BNP, LC and fluid responsiveness on admission are associated with septic shock and SHD with HF patients in - hospital 28 days mortality.