动态监测脓毒症患者心功能变化评估短期死亡的价值分析  

Value of dynamic monitoring of cardiac function to predict short-term death in patients with sepsis

作　　者：陈栩栩[1] 陈君[1] 李景辉[1] CHEN Xuxu;CHEN Jun;LI Jinghui(Department of Emergency Medicine,Haikou People's Hospital,Haikou Hainan 570208,China)

机构地区：[1]海口市人民医院重症医学科,海南海口570208

出　　处：《中国急救复苏与灾害医学杂志》2022年第8期1070-1073,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：海南省自然科学基金项目(编号:819MS139)。

摘　　要：目的研究动态监测脓毒症患者心功能变化评估短期死亡的价值。方法回顾性分析海口市人民医院重症2017年2月—2020年2月97例脓毒症患者的临床资料,根据随访1年内是否发生死亡事件将患者分为死亡组(n=24)和存活组(n=73)。收集两组患者性别、年龄、身体质量指数(BMI)、饮酒、吸烟、高血压、血糖、慢性肺病、慢性肾病、急性生理与慢性健康(APACHEII)评分及钙(Ca)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、左心室射血分数(LVEF)、左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、血流速度E峰与A峰比值(E/A)、血流速度E峰与运动速度E'峰比值(E/E')水平各项信息。将两组有差异信息纳入Logistic模型,行量化赋值,以预后作为因变量(Y,存活=0、死亡=1),以APACHEII评分及Ca、IL-6、TNF-α、CRP、LVEF、LVESD、LVEDD、E/A、E/E'水平为自变量(X),明确影响脓毒症患者短期死亡的危险因素。结果两组性别、年龄、BMI、饮酒、吸烟、高血压、血糖、慢性肺病、慢性肾病比较无显著差异(P>0.05);死亡组APACHEII评分、IL-6、TNF-α、CRP、E/E'水平显著高于存活组,Ca、LVEF、LVESD、LVEDD、E/A显著低于存活组,差异有统计学意义(P<0.05)。多因素Logistic回归分析证实,APACHEII评分≥24.17分、Ca<1.93 mmol/L、IL-6≥25.58 mg/L、TNF-α≥28.02 pg/mL、CRP≥23.01 mg/L、LVEF<44.61%、LVESD<30.11 mm、LVEDD<45.33 mm、E/A<0.81、E/E'≥12.63是脓毒症患者死亡的危险因素(P<0.05)。结论脓毒症患者短期死亡受到APACHEII评分、Ca浓度、炎症因子、心功能影响,临床应给予密切关注,并及时作出干预,降低患者死亡率。Objective To investigate the value of dynamic monitoring of cardiac function in prediction of short-term death in the patients with sepsis.Methods 97 patients with sepsis were followed up for one year and were divided into 2 groups according to the prognosis:death group(n=24)and survival group(n=3).Related clinical data were surveyed.Peripheral fasting venous blood samples were collected to detect the serum calcium level by Merck test paper,levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)by ELISA,and C-reaction protein(CRP)level by immune turbidimetry.Transthoracic echocardiography was used to measure the left ventricle ejection fraction(LVEF),left ventricle end systolic diameter(LVESD),and left ventricular end-diastolic diameter(LVEDD),blood flow velocity E peak to A peak ratio(E/A),and blood flow velocity E peak to exercise velocity E'peak ratio(E/E').The related data:gender,age,body mass index(BMI),alcohol consumption,smoking,hypertension,blood glucose,chronic lung disease,chronic kidney disease,Aacute physiology and chronic health(APACHE II)score,etc.were collected.Unconditional logistic regression analysis was used to analyze the risk factors affecting the short-term death in patients with sepsis.Results There was no significant differences in gender,age,BMI,drinking,smoking,hypertension,blood glucose,chronic lung disease,and chronic kidney disease between these two groups(all P>0.05)The APACHE II score,and levels of IL-6,TNFα,CRP,and E/E'of the death group were all significantly higher than those of the survival group,and the levels of Ca,LVEF,LVESD,LVEDD and E/A were all significantly lower than those of the survival group(all P<0.05).Multivariate logistic regression analysis confirmed that APACHE II score≥24.17,Ca<1.93 mmol/L,IL-6≥25.58 mg/L and TNFα≥28.02 pg/mL,CRP≥23.01 mg/L,LVEF<44.61%,LVESD<30.11 mm,LVEDd<45.33 mm,E/A<0.81,and E/E'≥12.63 were the risk factors of death in the patients with sepsis(all P<0.05).Conclusion The short-term death of patients with sepsis is affecte

关 键 词：脓毒症 心功能 LOGISTIC回归分析 死亡 

分 类 号：R631[医药卫生—外科学]