脓毒症患者术后并发脓毒症心肌病的危险因素

Risk factors for postoperative septic cardiomyopathy in septic patients

目的筛选脓毒症患者术后并发脓毒症心肌病(SCM)的危险因素。方法纳入苏州大学附属第二医院、苏州大学附属第一医院及苏州市立医院2017年1月至2020年11月脓毒症术后入ICU治疗的患者,回顾性分析围术期资料。根据患者术后48 h内是否发生SCM分为SCM组与非SCM组(NSCM组)。采用多因素logistic回归分析筛选SCM的危险因素。结果最终共纳入患者269例,SCM组49例,NSCM组220例。与NSCM组比较,SCM组腔镜手术比率、入ICU时室序贯器官衰竭评分(SOFA)、入ICU时血清乳酸浓度、最高血清乳酸浓度、最高血清降钙素原浓度、去甲肾上腺素最大用量和最高体温升高,最低血小板计数降低(P<0.1)。logistic回归分析结果显示入室SOFA评分和腔镜手术是脓毒症患者术后并发SCM的危险因素(P<0.05);入室SOFA评分≥7分患者SCM发生风险增加34.273倍(P<0.05)。结论选择腔镜手术和术后入ICU时SOFA评分≥7分是脓毒症患者术后并发SCM的危险因素。

Objective To identify the risk factors for postoperative septic cardiomyopathy(SCM)in septic patients.Methods The perioperative medical records of septic patients admitted to the intensive care unit(ICU)of Second Affiliated Hospital of Soochow University,First Affiliated Hospital of Soochow University and Suzhou Municipal Hospital after surgery from January 2017 to November 2020 were retrospectively collected.The patients were divided into SCM group and non-SCM group(NSCM group)according to whether or not SCM developed within 48 h after operation.Multivariate logistic regression analysis was used to identify the risk factors for SCM.Results A total of 269 patients were included in this study,including 49 patients in SCM group and 220 patients in NSCM groups.Compared with group NSCM,the rate of laparoscopic surgery,the Sequential Organ Failure Assessment(SOFA)at the time of entering ICU,the serum concentration of lactate at the time of entering ICU,the highest serum concentration of lactate,the highest serum concentration of procalcitonin,the maximum consumption of norepinephrine and the highest body temperature were increased,and the minimum platelet count was decreased in group SCM(P<0.1).The results of logistic regression analysis showed that SOFA score at the time of entering ICU and laparoscopic surgery were the risk factors for the development of postoperative SCM in septic patients(P<0.05).The risk for SCM was increased by 34.273 times when the SOFA score at the time of entering ICU was≥7(P<0.05).Conclusion Laparoscopic surgery and SOFA score≥7 at the time of entering ICU are the risk factors for the development of postoperative SCM in septic patients.