后负荷心功能参数在脓毒症心肌病中的应用

The application value of afterload-related cardiac performance in patients with sepsis-induced cardiomyopathy

目的探讨后负荷心功能参数(ACP)在脓毒症心肌病中的应用价值。方法回顾性纳入2013年4月到2018年3月武汉市第四医院重症医学科收治的脓毒性休克患者148例,所有纳入患者依据左室射血分数(LVEF)分为LVEF<50%组和LVEF≥50%组,并比较2组患者28 d病死率与ACP值。将所有纳入患者依据ACP值分为正常组(ACP>80%)、轻度心功能损害组(60%<ACP≤80%)、中度心功能损害组(40%<ACP≤60%)、重度心功能损害组(ACP≤40%),比较4组患者28 d病死率。计量资料比较采用成组t检验,率的比较采用χ2检验。结果LVEF<50%组28 d病死率为58.2%,LVEF≥50%组28 d病死率为30.9%,其差异有统计学意义(χ2=11.171,P<0.01)。LVEF<50%组ACP值为(39.3±16.4)%,LVEF≥50%组ACP值为(69.1±14.9)%,其差异有统计学意义(t=11.571,P<0.01)。正常组28 d病死率为14.81%,轻度心功能损害组28 d病死率为44.00%,中度心功能损害组28 d病死率为58.82%,重度心功能损害组28 d病死率为90.00%,正常组与轻中度组比较差异有统计学意义,重度组与轻中度组比较差异有统计学意义。结论后负荷心功能参数对于脓毒症心肌病的诊断及预后判断具有重要价值。

Objective To investigate the application value of afterload-related cardiac performance(ACP)in patients with sepsis-induced cardiomyopathy.Methods A total of 148 patients with septic shock admitted by the department of critical care of Wuhan fourth hospital from April 2013 to March 2018 were retrospectively included,all included patients were divided into LVEF<50%group and LVEF≥50%group according to left ventricular ejection fraction(LVEF),the mortality rate at 28 days and ACP value were compared in the 2 groups.All included patients were divided into normal group(ACP>80%),mild heart function impairment group(60%<ACP≤80%),moderate heart function impairment group(40%<ACP≤60%),and severe heart function impairment group(ACP≤40%)according to ACP value,the mortality rate at 28 days was compared in the 4 groups.The measurement data were compared by grouped t test,the rates were compared by chi-square test.Results The mortality rate was 58.2%in the LVEF<50%group,and 30.9%in the LVEF≥50%group,with statistically significant differences(χ2=11.171,P<0.01).The values of ACP in the LVEF<50%group were(39.3±16.4)%,and those in the LVEF≥50%group were(69.1±14.9)%,with statistically significant differences(t=11.571,P<0.01).The mortality rate was 14.81%in the normal group,44.00%in the mild,58.82%in the moderate and 90.00%in the severe group.The differences between the normal group and the mild and moderate groups were statistically significant,while those between the severe group and the mild and moderate groups were statistically significant.Conclusion Afterload-related cardiac performance is of great value for the diagnosis and prognosis in patients with sepsis-induced cardiomyopathy.