脓毒性心肌病的发病率及危险因素分析

Analysis of incidence and risk factors of septic cardiomyopathy

目的研究脓毒性心肌病的发病率及危险因素,为脓毒性心肌病的诊治及预防提供依据。方法研究对象为2015年1月至2017年8月收入吉林大学第一医院重症医学科(ICU)的208例脓毒症或脓毒性休克成人患者(年龄≥18岁),采用回顾性研究的方法统计所有入选患者的临床资料,比较脓毒性心肌病组(n=39)和非脓毒性心肌病组(n=169)患者的基线资料及预后有无差异,采用多元logistic回归分析筛选和检验脓毒性心肌病相关危险因素。结果①脓毒性心肌病在脓毒症或脓毒性休克患者中发病率约为18.8%。②脓毒性心肌病组和非脓毒性心肌病组患者的基线体质量、心房颤动、高血压、糖尿病、恶性肿瘤、最高体温、血白细胞、C-反应蛋白(CRP)、降钙素原(PCT)、血培养阳性、住院病死率、30 d病死率等指标比较,差异无统计学意义(P>0.05)。两组患者的年龄(P=0.01)、性别(P=0.02)、心力衰竭病史(P=0.03)、冠心病病史(P=0.01)、入ICU时血小板(P=0.01)、入ICU时乳酸(P=0.02)、应用血管活性药物(P=0.03)、APACHEⅡ评分(P=0.03)、SOFA评分(P=0.01)、ICU住院时间(P=0.03)等指标比较,差异均有统计学意义。③既往有心力衰竭病史(OR=1.55,95%CI:0.73~1.66,P=0.01)、有冠心病病史(OR=1.18,95%CI:1.03~1.66,P=0.03)、入ICU时乳酸>4.0 mmol/L(OR=1.10,95%CI:1.00~1.30,P=0.04)时,脓毒性心肌病的发病率风险显著增高。结论脓毒性心肌病在脓毒症或脓毒性休克患者中发病率较高,既往有心力衰竭病史、冠心病病史、入ICU时乳酸>4.0 mmol/L是脓毒性心肌病的发病率的独立危险因素。

Objective To investigate the incidence and risk factors of septic cardiomyopathy, and to provide evidence for the diagnosis, treatment and prevention of septic cardiomyopathy. Methods Totally 208 patients with septic or septic shock (≥ 18 years old) were admitted to ICU Department of The First Hospital of Jilin University from January 2015 to August 2017. The clinical data of all patients were retrospectively analyzed, and the baseline data and clinical outcomes were compared between the septic cardiomyopathy group (39 cases) and non-septic cardiomyopathy group (169 cases). Multiple Logistic regression analysis was used to analyze the risk factors of septic cardiomyopathy. Results (1) The incidence of septic cardiomyopathy in patients with septic or septic shock was about 18.8%.(2) There was no signifi cant difference in baseline body weight, atrial fibrillation, hypertension, diabetes, malignant tumor, maximum body temperature, blood leukocyte, C-reactive protein(CRP), procalcitonin(PCT), positive blood culture, in-hospital mortality and 30-day mortality between the two groups (all P>0.05). Age (P=0.01), sex (P=0.02), history of heart failure (P=0.03), history of coronary heart disease (P=0.01), platelet at ICU admission (P=0.01), lactic acid at ICU admission (P=0.02), vasoactive drugs (P=0.03), APACHE Ⅱ score (P=0.03), SOFA score (P=0.01), and ICU length of hospital stay (P=0.03) were significantly different between the two groups.(3) Patients with a history of heart failure (OR=1.55, 95%CI:0.73-1.66;P=0.01), a history of coronary heart disease (OR=1.18, 95%CI: 1.03- 1.66;P=0.03), and lactic acid at ICU admission > 4.0 mmol/L (OR=1.10, 95%CI: 1.00-1.30;P=0.04) were independent risk factors for the incidence of septic cardiomyopathy. Conclusion Septic cardiomyopathy has a relatively high incidence in patients with septic or septic shock. Patients with a history of heart failure, a history of coronary heart disease and lactic acid at ICU admission > 4.0 mmol/L are independent risk factors for the incidence of septic cardiomyopathy.