脓毒症心肌损伤患者的预后影响因素分析  

Prognostic factors in patients with sepsis-related myocardial injury

作　　者：张萌[1] 段美丽[1] 林瑾[1] 支德源 郭东晨[1] ZHANG Meng;DUAN Mei-li;LIN jin(Department of Critical Care Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院重症医学科,北京100050

出　　处：《临床和实验医学杂志》2020年第8期846-849,共4页Journal of Clinical and Experimental Medicine

基　　金：北京市医院管理局重点医学专业发展计划(编号:ZYLX201802)。

摘　　要：目的探讨影响脓毒症心肌损伤患者预后的相关危险因素。方法回顾性分析2013年1月至2018年12月首都医科大学附属北京友谊医院收治的147例脓毒症心肌损伤患者的病例资料,研究终点为患者28 d死亡,按照预后将患者分为生存组和死亡组,采用多元Logistic回归分析法分析两组患者的临床资料,分析影响患者死亡预后的危险因素。结果147例患者中,其中66例死亡,死亡率为44.89%,单因素分析显示,与生存组相比,死亡组(n=66,44.89%)患者高血压比率高,以肺部感染为感染源比率高,血糖、血肌酐、血清钾离子水平高,7 d累积液体正平衡多,急性生理与慢性健康评分II(APACHEⅡ评分)、全身感染相关性序贯器官衰竭评分(SOFA评分)高,使用机械通气、血管活性药物、合并急性肾损伤比率大;而生存组24 h乳酸清除率高于死亡组。根据单因素分析筛选指标,进行多元logistic回归分析显示,24 h乳酸清除率(OR=0.348,95%CI:0.155~0.786,P=0.011)、APACHE II评分(OR=2.037,95%CI:1.970~2.109,P=0.028)、肺部感染(OR=4.556,95%CI:1.527~13.593,P=0.007)、合并急性肾损伤(OR=21.443,95%CI:4.119~43.879,P<0.01)是影响脓毒症心肌损伤患者预后的独立危险因素。结论脓毒症心肌损伤患者病死率高,24 h乳酸清除率、APACHEⅡ评分、肺部感染和合并急性肾损伤是影响其预后的危险因素。Objective To identify prognostic factors in patients with sepsis-related myocardial injury.Methods A retrospective study was conducted in 147 patients with sepsis-related myocardial injury who were admitted to the Department of Critical Care Medicine in Beijing Friendship Hospital,Capital Medical University from January 2013 to December 2018.According to whether these patients survived after 28 days,they were divided into the survived group and the death group.Demographic and clinical parameters were retrieved and compared between the two groups.Logistic multivariate regression analysis was performed to determine the risk factors related to mortality.Results Among the 147 patients included,66 patients(44.89%)died after 28 days.Compared with the survived group,Patients in death group(n=66,44.89%)had higher prevalence of hypertension,higher proportion of pneumonia,higher level of blood glucose,serum creatinine and serum potassiumion.In addition,the 7-day cumulative fluid of this group were more,the Acute Physiology and Chronic Health Evaluation II score(APACHE II score)and the Sepsis-related Organ Failure Assessment score(SOFA score)were higher,and they were more likely to be mechanically ventilated or treated with vasopressors or suffered with acute kidney injury.Patients in the survived group had higher 24-hour lactate clearance rate.Multivariate Logistic regression analysis revealed that 24-hour lactate clearance rate(OR=0.348,95%CI:0.155-0.786,P=0.011),APACHE II score(OR=2.037,95%CI:1.970-2.109,P=0.028),pneumonia(OR=4.556,95%CI:1.527-13.593,P=0.007),acute kidney injury(OR=21.443,95%CI:4.119-43.879,P<0.01)were independent risk factors for mortality.Conclusion The mortality of patients with sepsis-related myocardial injury was high.24-hour lactate clearance rate,APACHE II score,pulmonary infection,acute kidney injury were risk factors for mortality in patients with sepsis-related myocardial injury.

关 键 词：脓毒症 心肌损伤 预后 影响因素 

分 类 号：R459.7[医药卫生—急诊医学] R542.2[医药卫生—治疗学]