脓毒症新发心律失常的影响因素分析

Analysis of Influencing Factors of New-onset Arrhythmia in Sepsis

背景脓毒症是感染导致的全身炎症反应综合征,本研究组前期研究发现,脓毒症新发心律失常的发生率较高,为34.48%,而单纯的炎性因子升高尚不能解释脓毒症新发心律失常的原因。目的分析脓毒症新发心律失常的影响因素,以为早期预测及治疗脓毒症新发心律失常患者提供新的研究方向及理论依据。方法回顾性选取2018年9月—2020年1月新疆医科大学第一附属医院急诊科、急诊重症监护室、重症监护室及呼吸重症监护室中的脓毒症患者243例为研究对象。根据患者是否新发心律失常将其分为脓毒症组146例和脓毒症新发心律失常组97例。收集患者一般资料及入院24 h内实验室检查指标。采用多因素Logistic回归分析探讨脓毒症新发心律失常的影响因素。结果多因素Logistic回归分析结果显示,入院时体温〔OR=1.419,95%CI(1.083,1.860)〕、国际标准化比值(INR)〔OR=1.576,95%CI(1.006,2.469)〕、肌酸激酶同工酶(CK-MB)〔OR=1.028,95%CI(1.003,1.055)〕、N末端脑钠肽前体(NT-proBNP)〔OR=1.003,95%CI(1.001,1.005)〕是脓毒症新发心律失常的独立影响因素(P<0.05)。结论入院时体温、INR、CK-MB、NT-proBNP是脓毒症新发心律失常的影响因素,临床工作中可针对上述影响因素进行干预以预防脓毒症新发心律失常的发生。

Background Sepsis is a systemic inflammatory response syndrome caused by infection.Our previous study found that the incidence of new-onset arrhythmias in sepsis was high(34.48%),and the pure elevation of inflammatory factors could not explain the cause of new-onset arrhythmias in sepsis.Objective To analyze the influencing factors of new-onset arrhythmia in sepsis and to provide a new research direction and theoretical basis for early prediction and treatment of new-onset arrhythmia in sepsis.Methods A total of 243 sepsis patients in the Department of Emergency,Emergency Intensive Care Unit,Intensive Care Unit and Respiratory Intensive Care Unit of First Affiliated Hospital of Xinjiang Medical University from September 2018 to January 2020 were retrospectively selected as the research subjects.The patients were divided into sepsis group(n=146)and sepsis-new-onset arrhythmias group(n=97)according to whether they had new-onset arrhythmias.General information and laboratory examination indexes within 24 hours after admission were collected.Multivariate Logistic regression analysis was used to investigate the influencing factors of new-onset arrhythmia in sepsis.Results The results of multivariate Logistic regression analysis showed that body temperature on admission〔OR=1.419,95%CI(1.083,1.860)〕,international normalized ratio(INR)〔OR=1.576,95%CI(1.006,2.469)〕,creatine kinase isoenzyme(CK-MB)〔OR=1.028,95%CI(1.003,1.055)〕,N-terminal pro brain natriuretic peptide(NT-proBNP)〔OR=1.003,95%CI(1.001,1.005)〕were independent influencing factors of new-onset arrhythmia in sepsis(P<0.05).Conclusion Body temperature on admission,INR,CK-MB and NT-proBNP are the influencing factors of new-onset arrhythmias in sepsis.The above-mentioned influencing factors can be intervened in clinical work to prevent the occurrence of new-onset arrhythmias in sepsis.