红细胞体积分布宽度与脓毒症心功能不全预后的关系

Correlation of red blood cell distribution with prognosis of sepsis-induced cardiac dysfunction

目的监测脓毒症患者红细胞体积分布宽度(RDW)、脑钠肽(BNP)水平以及心肌收缩功能,探讨RDW与脓毒症心功能不全的预后关系。方法回顾性分析深圳市龙岗区人民医院和中山大学孙逸仙纪念医院重症医学科病房2011年3月至2015年7月入住ICU诊断为脓毒症心功能不全的35例患者的临床资料,按其预后分为死亡组14例和存活组21例,所有患者均测定BNP及RDW水平,并通过脉波指示剂连续心排量(PiCCO)对患者进行血流动力学监测,记录心指数(CI)、心功能指数(CFI)、全心射血分数(GEF)、左心室收缩力指数(dP/dPmax),同时进行急性生理学及慢性健康评估(APACHEⅡ)评分。选取20例健康体检者作为对照组。结果与死亡组相比,存活组患者的RDW[(14.1±2.3)vs(16.5±2.8)]水平明显降低,差异有统计学意义(P<0.05);与死亡组相比,存活组患者的CI[(3.22±0.71)L/min·m^2vs(2.67±0.39)L/min·m^2]、CFI[(4.57±0.84)L/min vs(3.91±0.43)L/min]、GEF[(16.50±1.59)%vs(14.95±1.36)%]和dP/dPmax[(1 358.27±218.62)vs(1 093.71±245.19)]均明显增高,差异均有统计学意义(P<0.05);与死亡组比较,存活组患者的APACHEⅡ评分[(13.40±1.27)分vs(15.91±1.64)分]明显降低,差异有统计学意义(P<0.05)。结论 RDW有助于预测ICU中脓毒症心功能不全患者的预后,RDW水平升高提示预后不良。

Objective To observe the red blood cell distribution width （RDW）, brain natriuretic peptide （BNP） levels, and cardiac contractility in patients with sepsis, and to evaluate the relationship between RDW and the prognosis of sepsis-induced cardiac dysfunction. Methods A total of 35 sepsis-induced cardiac dysfimction patients admitted in ICU of Shenzhen Longgang People＇ s Hospital and Sun Yat-sen Memorial Hospital, Sun Yat-sen University from Mar. 2011 to Jul. 2015 were divided into survival group （n=21） and death group （n=14） according to the prognosis. The levels of RDW and BNP were measured. Moreover, hemodynamic monitoring was performed with pulse-indicated continuous cardiac output （PiCCO）, and cardiac index （CI）, cardiac function index （CFI）, global ejection fraction （GEF）, dP/dPmax from PiCCO were recorded. Acute physiology and chronic health evaluation （APACHE Ⅱ ） scores were determined. Twenty healthy volunteers were collected as the control group （n=20）. Results Compared with death group, the RDW and APACHEⅡ were significantly decreased in survival group （P〈0.05）： RDW （14.1±2.3） vs （16.5±2.8）, APACHE Ⅱ（13.40±1.27） vs （15.91± 1.64）. However, CI, CFI, GEF, and dP/dPmax were significantly increased in survival group （P〈 0.05）： CI （3.22±0.71） L/min-m2 vs （2.67±0.39） L/min. m2, CFI （4.57±0.84） L/min vs （3.91±0.43） L/rain, GEF （16.50± 1.59）% vs （14.95±1.36）%, dP/dPmax （1 358.27±218.62） vs （1 093.71±245.19）. Conclusion RDW is as a reliable indica- tor to predict the prognosis of sepsis-induced cardiac dysfunction, and increased RDW indicates a poor prognosis.