脓毒症继发心功能障碍患者短期预后及其影响因素

Short-term Prognosis of Patients with Sepsis Induced Myocardial Dysfunction and Its Influence Factors

目的:研究脓毒症继发心功能障碍(sepsis induced myocardial dysfunction,SIMD)患者短期预后及其影响因素。方法:选取2020年1月—2022年3月龙岩人民医院住院治疗的82例SIMD患者为研究对象。随访30 d记录患者生存情况。收集整理患者临床资料。比较两组年龄、性别、感染部位、心率(HR)、平均动脉压(MAP)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、心肌肌钙蛋白T(cTnT)、降钙素原(PCT)、N末端B型脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、24 h乳酸清除率(LCR)、左室射血分数(LVEF)及舒张早期二尖瓣血流速度与舒张早期二尖瓣环运动速度的比值(E/A)。采用多因素分析SIMD患者预后的影响因素。结果:随访30 d,40例(48.78%)患者死亡,纳入不良组,42例纳入良好组。不良组年龄、HR、APACHEⅡ评分、SOFA评分、NT-proBNP水平均高于良好组,24 h LCR、MAP、E/A均低于良好组,差异有统计学意义(P<0.05)。年龄、APACHEⅡ评分、SOFA评分、NT-proBNP均为SIMD患者预后不良的危险因素,24 h LCR为SIMD患者预后不良的保护因素(P<0.05)。结论:SIMD患者预后较差,高龄,高APACHEⅡ评分、SOFA评分及NT-proBNP均为SIMD患者预后不良的危险因素,而高24 h LCR为其保护性因素。

Objective:To study the short-term prognosis of patients with sepsis induced myocardial dysfunction(SIMD)and its influence factors.Method:A total of 82 patients with SIMD who were hospitalized for treatment in Longyan People's Hospital from January 2020 to March 2022 were selected as the research objects.Patients were followed up for 30 days to record their survival condition.Clinical data of patients were collected and sorted out.The age,sex,infection site,heart rate(HR),mean arterial pressure(MAP),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment score(SOFA),cardiac muscle troponin T(cTnT),procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-proBNP),creatine kinase isoenzyme(CK-MB),24 h lactate clearance rate(LCR),left ventricular ejection fraction(LVEF)and the ratio of early diastolic mitral flow velocity to early diastolic mitral annular motion velocity(E/A)were compared between the two groups.Multivariate analysis was used to analyze the prognostic influence factors of SIMD patients.Result:After 30 days of follow-up,40 patients(48.78%)died and were included in the poor group and 42 patients were included in the good group.The age,HR,APACHEⅡscore,SOFA score and NT-proBNP level of the poor group were higher than those of the good group,and the 24 h LCR,MAP and E/A were lower than those of the good group,and the differences were statistically significant(P<0.05).Age,APACHEⅡscore,SOFA score and NT-proBNP were risk factors for poor prognosis of SIMD patients,and 24 h LCR was a protective factor for poor prognosis of SIMD patients(P<0.05).Conclusion:The prognosis of SIMD patients is poor.The elderly,high APACHEⅡscore,SOFA score and NT-proBNP are the risk factors for poor prognosis of SIMD patients,while high 24 h LCR is the protective factor.