脓毒性休克伴心肌抑制患者死亡风险分析

Analysis of the mortality risk in septic shock patients with myocardial depressio~

目的 分析脓毒性休克伴心肌抑制患者的死亡风险。 方法 入选2015~2016年入住ICU的脓毒性休克患者，射血分数（EF）＜50%纳入心肌抑制组，EF≥50%纳入非心肌抑制组。比较两组患者入院6 h内 CRP、PCT、Lac，入院24~48 h CRP、PCT、Lac、BNP、cTnI、SOFA评分、去甲肾上腺素平均剂量。多因素Cox风险回归法分析脓毒症患者死亡风险，并比较两组的死亡风险。 结果 132例患者纳入研究，心肌抑制组24~48 h Lac、BNP、cTnI、SOFA评分、去甲肾上腺素平均剂量较非心肌抑制组高，差异有统计学意义（P＜0.05）。多因素Cox风险回归分析显示，入院24~48 h Lac、BNP、cTnI、SOFA评分、去甲肾上腺素平均剂量及心肌抑制是脓毒性休克患者死亡的危险因素，差异有统计学意义（P＜0.05）。其中心肌抑制组患者14 d死亡风险较非心肌抑制组增高95.2%，差异有统计学意义（P＜0.05）。分析14 d后存活患者1年内生存情况，两组差异无统计学意义。 结论 心肌抑制患者14 d死亡风险增加95.2%。14 d后存活患者1年内死亡风险无差异。

Objective The purpose of this study was to analyze the death risk in septic shock patients with myocardial depression. Methods Patients with septic shock in our ICU were rectuited during the year 2015 and 2016. Patients with EF 〈 50% were recruited to myocardial depression group, and the others were recruited to non - myocardial depression group. The differences of CRP, PCT, Lac which obtained within 6 hours of hospitalization between two groups were analyzed. The differences of CRP, PCT, Lac, BNP, cTnI, SOFA score, average dose of norepinephrine obtained within 24 -48 hours of hospitalization between two groups were analyzed. Multivariate Cox regression analysis was used to analyze the death risk of septic shock patients and its difference between two groups. Results 132 patients were recruited in the study. Patients＇ 24 -48 h Lac, BNP, cTnI, SOFA scores and the average dosage of norepinephrineof the myocardial depression group were higher than those of the non - myocardial depression group, and the difference was statistically significant （ P 〈 0.05 ）. Multivariate Cox risk regression analysis showed that 24 - 48 h Lac, BNP, cTnI, SOFA score, average dose of norepinephrine and myocardial depression were risk factors for death in septic shock patients, and the difference was statistically significant（P 〈 0.05）. 14 days＇ death risk of the patients in the myocardial depression group was 95.2% significantly higher than that in the non- myocardial depression group（P 〈 0. 05 ）. The Annual risk of death was analyzed in patients who were still alive after 14 days＇ hospitalization, and the difference between two groups was not statistically significant. Conclusion The 14 days＇ mortality risk factors of septic shock patients are 24 ~ 48 h Lac, BNP, cTnI, SOFA, the average dose of norepinephrine, and myocardial depression. The risk of death for 14 days in patients with myocardial depression is increased by 95.2%. There is no difference in annual mortality risk between the patients who are still alive after 14 days＇ hospitalization in two groups.