脓毒症心功能障碍患者预后影响因素分析

Factors Associated with the Prognosis of Sepsis-induced Myocardial Dysfunction

目的探讨脓毒症心功能障碍(SIMD)患者预后的影响因素。方法选取2015年8月—2017年8月就诊于新疆医科大学第一附属医院急诊抢救室、EICU的符合脓毒症或脓毒性休克合并SIMD患者87例,记录患者一般资料、实验室检查指标及心脏超声,随访28 d根据预后分为死亡组(56例)和存活组(31例)。采用多因素Cox比例风险回归模型分析影响预后的因素,采用Kaplan-meier方法绘制生存曲线,组间生存率的比较采用Log-rank检验。结果多因素Cox比例风险回归模型分析结果显示,年龄[HR=1.011,95%CI(1.001,1.022)]、平均动脉压[HR=0.985,95%CI(0.975,0.996)]、心率[HR=1.012,95%CI(1.004,1.021)]、N末端脑钠肽前体(NT-proBNP)[HR=1.010,95%CI(1.009,1.023)]、新发心律失常[HR=1.875,95%CI(1.415,2.686)]为SIMD患者预后的独立影响因素(P<0.05)。Log-rank检验显示,年龄≤65岁SIMD患者生存率高于>65岁者(χ~2=4.973,P=0.027),平均动脉压>65 mm Hg SIMD患者生存率高于≤65 mm Hg者(χ~2=8.040,P=0.005),心率≤104次/min SIMD患者生存率高于>104次/min者(χ~2=10.725,P=0.001),NT-proBNP水平≤1 972μg/L SIMD患者生存率高于>1 972μg/L者(χ~2=11.426,P=0.001),未新发心律失常SIMD患者生存率高于新发心律失常者(χ~2=6.524,P=0.011)。结论年龄、心率、NT-proBNP、新发心律失常为SIMD患者预后的独立危险因素,平均动脉压为其保护因素;PCT等炎性因子尚不能作为SIMD预后的独立影响因素。

Objective To explore the factors associated with the prognosis of patients with sepsis-induced myocardial dysfunction（SIMD）.Methods We enrolled 87 patients with sepsis or septic shock complicating SIMD from the Emergency Resuscitation Room and EICU,the First Affiliated Hospital of Xinjiang Medical University from August 2015 to August 2017.We collected their clinical data,laboratory findings and results of echocardiogram.In accordance with the outcome within 28 days after the definite diagnosis of sepsis,we divided them into death group（56 cases） and survival group（31 cases）.Multivariate Cox proportional hazards regression was used to explore the associated factors for the prognosis of SIMD.Survival analysis was conducted using Kaplan-meier method.Log-rank test was used to compare the survival rate between the groups.Results Multivariate Cox proportional hazards regression analysis showed that age [HR=1.011,95%CI（1.001,1.022）],mean arterial pressure（MAP） [HR=0.985,95%CI（0.975,0.996）],heart rate [HR=1.012,95%CI（1.004,1.021）],NT-proBNP [HR=1.010,95%CI（1.009,1.023）],arrhythmia [HR=1.875,95%CI（1.415,2.686）] were independent factors associated with the prognosis of SIMD patients（P〈0.05）.Log-rank test revealed that age equal to or less than 65 years old（χ~2=4.973,P=0.027）,MAP greater than 65 mm Hg（χ~2=8.040,P=0.005）,heart rate equal to or less than 104 beats/min（χ~2=10.725,P=0.001）,and NT-proBNP equal to or less than 1 972 μg/L（χ~2=11.426,P=0.001）,and without or with arrhythmia（χ~2=6.524,P=0.011） were associated with higher survival rate.Conclusion Age greater than 65 years old,heart rate greater than 104 beats/min,and NT-proBNP greater than 1 972 μg/L,arrhythmia are independent risk factors while MAP greater than 65 mm Hg is a protective factor associated with the prognosis of SIMD patients.PCT and other inflammatory factors showed no association with the prognosis of SIMD patients.