脓毒症心肌损伤后心脏舒缩功能的动态变化  

Dynamic changes of cardiac systolic and diastolic function after myocardial injury in patients with sepsis

作　　者：夏嘉鼎[1] 赵凯峰[1] 唐文斌 康大伟[3] 刘畅[1] 苏震 Jia-ding Xia;Kai-feng Zhao;Wen-bin Tang;Da-wei Kang;Chang Liu;Zhen Su(Department of Intensive Care Unit, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, China;Department of Intensive Care Unit, Kuancheng ManchuA utonomous County Hospital of Traditional Chinese Medicine, Kuancheng, Hebei 067600, China;Department of Emergency, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, China)

机构地区：[1]承德医学院附属医院重症医学科,河北承德067000 [2]宽城满族自治县中医院重症医学科,河北宽城067600 [3]承德医学院附属医院急诊科,河北承德067000

出　　处：《中国现代医学杂志》2019年第6期35-38,共4页China Journal of Modern Medicine

基　　金：河北省卫健委青年科技课题(No:20181164)

摘　　要：目的探讨心脏舒张、收缩功能和心肌损伤指标对脓毒症患者动态变化和预后判断的作用。方法收集脓毒症患者70例。根据28 d的预后分为生存组和死亡组。分别于入重症医学科(ICU)第1和3天应用床旁心脏超声测量二尖瓣舒张早期充盈峰速度E峰(E)与舒张晚期充盈峰速度A峰(A)、二尖瓣环舒张早期速度(e’)的比值,将E/e’及E/A作为评估左心室舒张功能的指标;测量左心室射血分数(LVEF)作为评估左心室收缩功能的指标。监测第1和3天心肌损伤标志物肌钙蛋白(cTnI)及肌酸激酶同工酶(CK-MB)水平。通过Logistic回归方法,对可能影响脓毒症预后的危险因素进行分析。结果两组患者于入ICU第3天的E/e’高于第1天(P<0.05),LVEF低于第1天(P<0.05);死亡组第1和3天的E/e’高于生存组(P<0.05)。两组第3天的cTnI、CK-MB高于第1天(P<0.05),死亡组第3天的cTnI高于生存组(P <0.05)。Logistic回归分析显示,E/e’[■4,(95%CI:1.116,1.982),P=0.003]、cTnI[■,(95%CI:0.907,1.432),P=0.039]是影响脓毒症患者28 d预后的危险因素。结论脓毒症患者存在心肌损伤,心脏舒张及收缩功能发生了动态变化,且高死亡风险脓毒症患者心脏舒缩功能及心肌损伤明显加重。E/e’、cTnI能预测脓毒症患者的预后。Objective To investigate dynamic changes of diastolic and systolic functions of cardiac and myocardial injury markers in patients with sepsis and risk factors which could affect prognosis. Methods Totally 70 patients with sepsis were divided into survival group and death group according to 28-day mortality. Patients in ICU underwent echocardiogram to measure velocities of early diastolic filling wave (E), late filling wave (A) and early diastolic velocity of the mitral annulus (e’) on the 1st day and 3rd day. E/e’ and E/A were used to evaluate left ventricular diastolic function. Left ventricular ejection fraction (LVEF) was measured as evaluation index of left ventricular systolic function on the 1st day and 3rd day, meanwhile levels of cardiac troponin (cTnI) and creatine kinase isoenzyme (CK-MB) were monitored. Logistic regression was used to analysis risk factors which could affect prognosis. Results Compared with data on the 1st day, E/e’ increased and LVEF decreased on the 3rd day in both groups (P < 0.05). Compared with survival group, E/e’ is higher on the 1st day and 3rd day in death group (P < 0.05);in addition, the levels of cTnI and CK-MB on the 3rd day were higher than those on the 1st day (P < 0.05), and the levels of cTnI on the 3rd day in the death group were higher than those in the survival group (P < 0.05). Logistic regression analysis showed that E/e’(OR=1.534,(95% CI: 1.116, 1.982), P = 0.003) and cTnI (OR =1.120,(95% CI: 0.907, 1.432), P = 0.039) were risk factors which could affect prognosis of sepsis. Conclusions Dynamic changes of cardiac systolic, diastolic function and myocardial injury are found in patients with sepsis. Cardiac function and myocardial injury are significantly aggravated in patients with high risk of death. E/e’ and cTnI have predictive value which could be beneficial to evaluate the prognosis of patients with sepsis.

关 键 词：脓毒症 心肌收缩 心肌舒张 肌钙蛋白I 

分 类 号：R459.7[医药卫生—急诊医学]