脓毒症心肌抑制患者血流动力学、器官功能及临床预后观察研究

Observation of Hemodynamics,Organ Function and Clinical Prognosis in Sepsis with Myocardial Depression

目的:分析脓毒症心肌抑制患者血流动力学、器官功能及临床预后。方法:选取2023年1月至2023年12月广西医科大学第二附属医院重症医学科收治的92例脓毒症患者作为研究对象进行回顾性分析,根据是否合并心肌抑制分为有心肌抑制组44例和无心肌抑制组48例,比较两组治疗后的血流动力学、器官功能及临床预后的情况。结果:心肌抑制组患者第1、4、8 d急性生理与慢性健康状况评分系统(APACHEⅡ)及SOFA评分均高于无心肌抑制组(P<0.05)。在入住ICU第1、4、8 d,有心肌抑制的患者左室舒张末期内径(LVEDD)、肺血管通透指数(PVPI)高于无心肌抑制的患者,心脏指数(CI)低于无心肌抑制的患者(P<0.05),两组患者在入住ICU的第1、4、8 d的中心静脉压(CVP)比较,差异无统计学意义(P>0.05)。两组患者总胆红素(TBIL)及氧合指数(OI)的比较,差异无统计学意义(P>0.05)。有心肌抑制组肌钙蛋白T(TnT)、B型脑钠肽(BNP)及肌酐(Cr)水平均较无心肌抑制组高(P<0.05)。有心肌抑制组的患者机械通气时间及ICU住院时间均小于无心肌抑制组的患者,差异无统计学意义(P>0.05)。两组28 d死亡率比较,差异无统计学意义(P>0.05)。结论:脓毒症心肌抑制可降低左室收缩功能,对28 d的死亡率影响不大,但对心功能及肾功能的影响较大。

Objective:To analyze hemodynamics and organ function in sepsis patients with myocardial depression.Methods:92 patients with sepsis who were admitted to the intensive care unit of the Second Affiliated Hospital of Guangxi Medical University fromJanuary to December in 2023 were selected,these patients were analyzed retrospec-tively.According to whether they were combined with myocardial depression,they were divided into two groups:44 pa-tients with myocardial depression and 48 patients without myocardial depression.The hemodynamics,organ function and clinical prognosis of the two groups were compared.Results:The acute physiology and chronic health score system(APACHEII)and SOFA scores of patients with myocardial depression on the 1st,4th and 8th days were higher than those of patients without myocardial depression(P<0.05).On the 1st,4th and 8th days after admission to ICU,the left ventricular end diastolic diameter(LVEDD)and pulmonary vascular permeability index(PVPI)of patients with myocar-dial depression were higher than those without myocardial depression,and the cardiac index(CI)was lower than those without myocardial depression(P<0.05).There was no significant difference in central venous pressure(CVP)between the two groups on the 1st,4th and 8th days after admission to ICU(P>0.05).There was no significant difference in total bilirubin(TBIL)and oxygenation index(OI)between the two groups(P>0.05).The levels of troponin T(TNT),B-type brain natriuretic peptide(BNP)and creatinine(CR)in the group with myocardial depression were higher than those in the group without myocardial depression(P<0.05).The duration of mechanical ventilation and ICU hospitaliza-tion time in patients with myocardial depression group were less than those in patients without myocardial depression group,and the difference was not statistically significant(P>0.05).There was no significant difference in 28th day mor-tality between the two groups(P>0.05).Conclusion:Myocardial depression in sepsis can reduce left ventricular systolic function,and has little effect on 28th day mortality,but has a great impact on cardiac function and renal function.