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作 者:周淑清[1] 沈涛 ZHOU Shu-qing;SHEN Tao(The People's Hospital of Liaoning Province,Shenyang110016,China)
机构地区:[1]辽宁省人民医院,沈阳110016 [2]北部战区空军医院
出 处:《内科急危重症杂志》2019年第6期478-481,共4页Journal of Critical Care In Internal Medicine
基 金:辽宁省科学技术基金(No:2019-ZD-0416)
摘 要:目的:探讨脓毒症新发心律失常的发生率、危险因素及其对预后的影响。方法:回顾性分析542例脓毒症患者的临床资料,根据是否新发心律失常,将患者分为新发心律失常组和非新发心律失常组,统计脓毒症患者新发心律失常的发生率、心律失常类型、住监护病房时间和28 d病死率,对新发心律失常可能的危险因素进行单因素和多因素回归分析。结果:542例脓毒症患者中158例新发心律失常,发生率29.15%。新发心律失常组急性生理学和慢性健康状况(APACHEⅡ)评分高于非新发心律失常组,住监护病房时间长于非新发心律失常组(均P<0.01)。单因素和多因素回归分析显示:年龄(OR=1.794,95%CI:1.166~2.760)、呼吸衰竭(OR=3.113,95%CI:0.744~13.022)、心力衰竭(OR=1.723,95%CI:0.970~3.059)、代谢紊乱(OR=2.459,95%CI:1.449~4.173)、急性肾损伤(OR=1.743,95%CI:0.978~3.106)、持续肾脏替代治疗(CRRT)(OR=5.951,95%CI:2.363~14.986)、机械通气(OR=16.713,95%CI:8.244~33.882)、儿茶酚胺药物使用(OR=6.472,95%CI:3.330~12.577)和凝血功能障碍(OR=6.686,95%CI:3.315~13.485)是脓毒症患者新发心律失常的危险因素。新发心律失常组病死率高于非新发心律失常组(51.27%vs 39.84%,P<0.05)。结论:脓毒症患者新发心律失常的发生率高,年龄、器官功能障碍、机械通气、CRRT及儿茶酚胺药物使用均是危险因素,新发心律失常延长了患者住监护病房时间,增加了28 d病死率。Objective:To investigate the incidence,risk factors and outcomes of new-onset arrhythmia in patients with sepsis.Methods:Clinical data of 542 patients with sepsis were analyzed retrospectively.Patients were divided into new-onset arrhythmia group and non-new-onset arrhythmia group.The incidence,intensive care unit(ICU)stay and 28-day mortality of new-onset arrhythmia in patients with sepsis were calculated.Univariate analysis and multivariate logistic analysis were performed on the possible risk factors of new-onset arrhythmia.Results:Among the 542 patients with sepsis,158 of them had new-onset arrhythmia with the incidence being 29.15%.The APACHII score was higher in new-onset arrhythmia group than that in non-new-onset arrhythmia group,and ICU stay was longer than non-new-onset arrhythmia group(all P<0.01).The statistical analysis showed that old age(OR=1.794,95%CI:1.166-2.760),respiratory failure(OR=3.113,95%CI:0.744-13.022),heart failure(OR=1.723,95%CI:0.970-3.059),metabolic disorder(OR=2.459,95%CI:1.449-4.173),acute kidney injury(OR=1.743,95%CI:0.978-3.106),continuous renal replacement therapy(CRRT)(OR=5.951,95%CI:2.363-14.986),mechanical ventilation(OR=16.713,95%CI:8.244-33.882),catecholamine drug(OR=6.472,95%CI:3.330-12.577)and blood coagulation dysfunction(OR=6.686,95%CI:3.315-13.485)were risk factors for sepsis patients developing new-onset arrhythmia.The mortality of new-onset arrhythmias group was higher than that of non-arrhythmia group was(51.27%vs 39.84%,P<0.05).Conclusion:The incidence of new-onset arrhythmias in patients with sepsis was high.Old age,organ dysfunction,mechanical ventilation,CRRT and catecholamine are all risk factors.New-onset arrhythmias not only extended the ICU stay,but also increased the fatality rate for 28 days.
分 类 号:R541.7[医药卫生—心血管疾病]
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