脓毒症心肌病短期预后及其影响因素研究  

The short-term prognosis and influencing factors of septic cardiomyopathy

作　　者：尹言 于君 王征[2] 张燕莉[3] 武德巍 李雪 冯洁 王燚 尹春琳[1] Yin Yan;Yu Jun;Wang Zheng;Zhang Yanli;Wu Dewei;Li Xue;Feng Jie;Wang Yi;Yin Chunlin(Department of Cardiology,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Diseases,Beijing 100032,China;不详)

机构地区：[1]首都医科大学宣武医院心内科,国家老年疾病临床医学研究中心,北京100032 [2]首都医科大学宣武医院急诊科,国家老年疾病临床医学研究中心,北京100032 [3]首都医科大学宣武医院神经生物室,国家老年疾病临床医学研究中心,北京100032

出　　处：《中国循证心血管医学杂志》2022年第4期451-453,464,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：北京市临床重点专科建设项目基金(京卫医【2018】204号)。

摘　　要：目的 分析脓毒症心肌病短期预后及其影响因素。方法 选取2017年8月至2020年10月于首都医科大学宣武医院收治的脓毒症心肌病患者86例,研究终点为15 d死亡,按其预后分为生存组(n=46)和死亡组(n=40),分析影响两组患者的预后因素。结果 回顾性分析显示:死亡组患者氧合指数及平均动脉压较生存组更低(P<0.05),其心率、肌酐及APACHEⅡ评分、SOFA评分均高于生存组,各部位感染率及急性肾衰发病率均远高于生存组,且合并高血压比率更高(55%vs.39.1%,P<0.05),而生存组24 h乳酸清除率明显高于死亡组(OR=0.352,95%CI:0.145~0.789,P=0.013),差异有统计学意义(P<0.05)。经多因素Logistic回归分析,24 h乳酸清除率、APACHEⅡ评分、肺部感染及合并急性肾损伤(AKI)是影响脓毒症心肌病患者预后的主要因素。结论 脓毒症心肌病具有极高的死亡率,其预后转归受多种因素影响,主要因素包括:24 h乳酸清除率、APACHEⅡ评分、各种感染及急性肾损伤等,其中24 h乳酸清除率为独立保护因素。Objective To analyze the short-term prognosis of septic cardiomyopathy and its influencing factors.Methods 86 patients with septic cardiomyopathy who were admitted to Xuanwu Hospital,Capital Medical University from August 2017 to October 2020 were selected.The endpoint of the study was 15 days after death.According to their prognosis,they were divided into the survival group(n=46) and the death group(n=40).Analyze the prognostic factors that affect the two groups of patients.Results A retrospective analysis showed that the death group’s oxygenation index and mean arterial pressure were lower than those of the survival group(P<0.05),and their heart rate,creatinine,APACHE Ⅱ score,and SOFA score were higher than those of the survival group.The incidence rate of various infections and the incidence of acute renal failure in the death group were much higher than that of the survival group,and the rate of complicated hypertension was higher(55% vs.39.1%,P<0.05).The survival group’s 24h lactate clearance rate was significantly higher than that of the death group(OR=0.352,95%CI:0.145~0.789,P=0.013).The difference is statistically significant(P<0.05).After multivariate logistic regression analysis,24h lactate clearance rate,APACHE Ⅱ score,lung infection,and AKI were the main factors affecting patients with septic cardiomyopathy.Conclusion Septic cardiomyopathy has a very high mortality rate,and its prognosis is affected by many factors.The main factors include 24h lactic acid clearance rate,APACHE Ⅱ score,various infections,and acute kidney injury.Besides,the 24-h lactate clearance rate was an independent protective factor.

关 键 词：脓毒症心肌病 乳酸清除率 APACHEⅡ评分 急性肾损伤 

分 类 号：R542.2[医药卫生—心血管疾病]