老年脓毒症相关心脏舒张功能不全患者的心肌损伤情况及危险因素分析  

Analysis on myocardial injury and risk factors in elderly patients with sepsis-related ventricular diastolic dysfunction

作　　者：夏嘉鼎[1] 刘畅[1] 康大伟[1] 苏震 赵凯峰[1] 滑立伟[1] XIA Jiading;LIU Chang;KANG Dawei;SU Zhen;ZHAO Kaifeng;HUA Liwei(Department of Critical Care Medicine,the Affiliated Hospital of Chengde Medical College,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

出　　处：《临床急诊杂志》2022年第1期25-29,共5页Journal of Clinical Emergency

基　　金：河北省卫生厅青年科技课题(No:20181164);河北省政府资助临床医学优秀人才培养项目(2021年);承德医学院附属医院青年科研基金项目。

摘　　要：目的:分析老年脓毒症相关心脏舒张功能不全患者的心肌损伤情况及危险因素。方法:收集老年脓毒症患者92例,行床旁心脏超声检查,根据心脏舒张功能是否不全分为脓毒症相关心脏舒张功能不全组(观察组)和心脏舒张功能正常组(对照组),于入院第1天及第3天行心肌损伤标志物检查并比较2组患者的临床特征。采用logistic回归模型分析脓毒症患者发生心脏舒张功能不全的独立危险因素。结果:脓毒症患者发生心脏舒张功能不全的比例为41.3%(38/92),即观察组38例。与对照组(54例)相比,观察组患者年龄更大,既往有高血压病史者所占比例更高(均P<0.05);在心肌损伤方面,2组于第3天肌钙蛋白I(cTnI)及肌酸激酶同工酶CK-MB均高于第1天(均P<0.05),且观察组在第3天cTnI水平高于对照组(P=0.012)。logistic回归模型分析显示患者年龄(OR=2.184,95%CI:1.129~3.320)、cTnI(OR=1.964,95%CI:1.573~2.495)是预测脓毒症患者发生心脏舒张功能不全的独立危险因素(均P<0.05)。结论:老年脓毒症相关心脏舒张功能不全患者发生心肌损伤的情况更为严重,而年龄、cTnI是发病的高危因素。Objective: To study the myocardial injury and risk factors in elderly patients with sepsis-related ventricular diastolic dysfunction. Methods: Ninety-two elderly patients with sepsis underwent echocardiogram were divided into diastolic dysfunction group(observation group) and normal diastolic function group(control group). Meanwhile, levels of the markers of myocardial injury and clinical characteristics were monitored in 1 st day and 3 rd day. Logistic regression was performed to analyze the independent risk factors of diastolic dysfunction in patients with sepsis. Results: In patients with sepsis, diastolic dysfunction accounted for 41.3%(38/92). Observation group had older age and more patients with history of hypertension than control group(all P<0.05). In terms of myocardial injury, compared with 1 st day, cTnI and CK-MB elevated in 3 rd day in both groups(all P<0.05). In addition, compared with control group, cTnI elevated in 3 rd day in observation group(P=0.012). Logistic regression analysis showed that age(OR=2.184, 95%CI: 1.129-3.320), cTnI(OR=1.964, 95%CI: 1.573-2.495) were the independent risk factors associated with diastolic dysfunction in patients with sepsis(all P<0.05). Conclusion: Myocardial injury is more serious in elderly patients’ sepsis-related ventricular diastolic dysfunction. Age and cTnI are high risk factors.

关 键 词：脓毒症 心脏舒张功能 心肌损伤 肌钙蛋白I 老年 

分 类 号：R631.2[医药卫生—外科学]