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神经重症患者发生神经源性心肌损伤的危险因素分析

Risk factors of neurogenic myocardial injury in neurointensive care patients
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摘要 目的探讨神经重症患者发生神经源性心肌损伤的危险因素。方法收集2018年10月至2019年12月浙江省人民医院收治的271例神经重症患者。记录患者的基本信息、既往病史、入院相关指标及住院相关指标。采用二元logistic回归筛选发生神经源性心肌损伤的危险因素。结果271例神经重症患者中神经源性心肌损伤的发生率为70.1%(190/271)。多因素logistic回归分析发现患者发生神经源性心肌损伤的危险因素为性别(女性∶男性,OR=2.6419,95%CI:1.2790-5.4569,P=0.0087)、BMI(BMI≥24 kg/m2∶<24 kg/m2,OR=3.6236,95%CI:1.8219-7.2070,P=0.0002)、Glasgow昏迷评分(GCS)评分(7-8分∶3-4分,OR=0.3142,95%CI:0.1457-0.6777,P=0.0032)、急性生理与慢性健康Ⅱ(APACHEⅡ)评分(≥25分∶≤16分,OR=2.8833,95%CI:1.1134-7.4664,P=0.0292)、ICU住院时间(9-15 d∶0-3 d,OR=6.1388,95%CI:1.6883-22.3202,P=0.0059;≥16 d∶0-3 d,OR=6.4070,95%CI:1.5219-26.9729,P=0.0113)、急性肾损伤(AKI)(出现∶未出现,OR=3.9478,95%CI:2.0051-7.7730,P=0.0001)是神经重症患者发生神经源性心肌损伤的危险因素。结论神经重症患者发生神经源性心肌损伤的风险较高,临床应引起高度重视;女性、超重的患者更容易发生;GCS评分、APACHEⅡ评分、ICU住院时间、住院期间是否出现AKI是神经重症患者发生神经源性心肌损伤的危险因素。 Objective To investigate the risk factors of neurogenic myocardial injury in neurointensive care patients.Methods The clinical data of 271 neurointensive care patients admitted in Zhejiang Provincial People's Hospital from October 2018 to December 2019 were retrospectively analyzed.The risk factors of neurogenic myocardial injury in patients were evaluated by SPSS 22.0 software and binary multivariate logistic regression analysis.Results Of the 271 neurointensive care patients,190(70.1%)had neurogenic myocardial injury.Multivariate logistic regression analysis showed that the risk factors of neurogenic myocardial injury in neurointensive care patients were as follows:female sex(OR=2.6419,95%CI:1.2790-5.4569,P=0.0087),BMI≥24 kg/m2(OR=3.6236,95%CI:1.8219-7.2070,P=0.0002),GCS 7-8(OR=0.3142,95%CI:0.1457-0.6777,P=0.0032),APACHEⅡscore≥25(OR=2.8833,95%CI:1.1134-7.4664,P=0.0292),length of ICU stay 9-15 days(OR=6.1388,95%CI:1.6883-22.3202,P=0.0059),length of ICU stay≥16 days(OR=6.4070,95%CI:1.5219-26.9729,P=0.0113),incidence of AKI(OR=3.9478,95%CI:2.0051-7.7730,P=0.0001).Conclusion The incidence of neurogenic myocardial injury in neurointensive care patients is high,female patients、overweight patients are more prone to neurogenic myocardial injury,GCS,APACHEⅡscore,length of stay in ICU,incidence of AKI can be used to predict the incidence of neurogenic myocardial injury.
作者 陈略 蔡文伟 金森军 孙叶青 CHEN Lue;CAI Wenwei;JIN Senjun;SUN Yeqing(Department of Emergency Medicine,Zhejiang Provincial People's Hospital(People's Hospital of Hangzhou Medical College),Hangzhou 310014,China)
出处 《浙江医学》 CAS 2021年第14期1522-1525,1540,共5页 Zhejiang Medical Journal
基金 浙江省卫生健康委员会青年人才项目(2019323925)。
关键词 神经重症 神经源性心肌损伤 危险因素 Neurointensive care Neurogenic myocardial injury Risk factors
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