脓毒症心肌损伤患者临床特征及危险因素研究

Clinical characteristics and risk factors of myocardial injury in patients with sepsis

目的分析脓毒症并发心肌损伤的临床特征及危险因素。方法前瞻性分析北京友谊医院2016年4月至2017年12月收治的脓毒症患者160例,根据是否出现心肌损伤分为心肌损伤组和非心肌损伤组,比较两组一般情况、实验室检查及超声心动图指标,分析脓毒症并发心肌损伤患者的临床特征。应用二元Logistic回归分析脓毒症并发心肌损伤的独立危险因素。结果160例脓毒症患者中75例出现心肌损伤(46.9%)。与非心肌损伤组相比,心肌损伤组年龄更大,既往高血压病史者比例更多(P<0.05)。脓毒症患者心功能障碍以舒张功能障碍为主(84.1%),收缩功能障碍占4.3%,室壁运动异常者占17.3%。与非心肌损伤组相比,心肌损伤组更易出现室壁运动异常(9.6%vs25.8%,P=0.012)、室间隔振幅[(0.87±0.16)vs(0.80±0.21),P=0.03]、舒张末期左室后壁振幅更低[(1.03±0.21)vs(0.96±0.18),P=0.034]、左心室短轴缩短指数更低(P=0.033)。Logistic回归分析显示高龄(RR=1.033,P=0.0180)和左心室短轴缩短指数减低(RR=0.000,P=0.024)为心肌损伤的独立危险因素。结论高龄和左心室短轴缩短指数减低是脓毒症并发心肌损伤的独立危险因素。

Objective To analyze the clinical characteristics and risk factors of myocardial injury(MI)in patients with sepsis.Methods Totally 160 patients with sepsis in April 2016 to December 2017,divided into the MI group and non-MI group.The clinical data laboratory findings and ultrasonic cardiographic findings were recorded and compared between the two groups.Binary logistic regression analysis was performed to find the independent risk factors of MI in patients with sepsis.Results Total of 160 patients with sepsis 75(46.9%)patients developed MI.The MI group had older age and more patients with history of hypertension than the non-MI group(P<0.05).In patients with sepsis,diastolic dysfunction accounted for 84.1%,systolic dysfunction accounted for 4.3%,and ventricular wall dyskinesia accounted for 17.3%.Compared with the non-MI group,the MI group had more abnormal wall motion(9.6%vs 25.8%,P=0.012),lower interventricular septal amplitude(0.87±0.16 vs 0.80±0.21,P=0.03)and left ventricular posterior wall amplitude(1.03±0.21 vs 0.96±0.18,P=0.034),and decreased fractional shortening(P=0.033).Binary logistic regression analysis showed that age(RR=1.033,P=0.018)and decreased fractional shortening(RR=0.000,P=0.024)were independent risk factors of MI in patients with sepsis.Conclusions Age and decreased fractional shortening were independent risk factors of myocardial injury in patients with sepsis.