超声心动图心室功能指标与脓毒症患者预后关系的研究  

Study on the relationship between ventricular function parameters obtained by echocardiography and prognosis of patients with sepsis

作　　者：卢年芳 於江泉 邵俊 韩文勇 关廼哲 郑瑞强 席修明 Lu Nianfang;Yu Jiangquan;Shao Jun;Han Wenyong;Guan Naizhe;Zheng Ruiqiang;Xi Xiuming(Department of Critical Care Medicine,Beijing Electric Power Hospital,State Grid Corporation of China,Beijing 100073,China;Department of Critical Care Medicine,Subei People's Hospital of Jiangsu Province,Yangzhou University,Yangzhou 225001,Jiangsu,China;Department of Anesthesiology,Beijing Electric Power Hospital,State Grid Corporation of China,Beijing 100073,China;Department of Blood Transfusion,Beijing Electric Power Hospital,State Grid Corporation of China,Beijing 100073,China;Department of Critical Care Medicine,Fuxing Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]国家电网公司北京电力医院重症医学科,北京100073 [2]扬州大学附属江苏省苏北人民医院重症医学科,江苏扬州225001 [3]国家电网公司北京电力医院手术麻醉科,北京100073 [4]国家电网公司北京电力医院输血科,北京100073 [5]首都医科大学附属北京复兴医院重症医学科,北京100038

出　　处：《中华危重病急救医学》2022年第7期740-745,共6页Chinese Critical Care Medicine

基　　金：国家科技支撑计划项目(2012BAI11B05)。

摘　　要：目的观察脓毒性心肌病的流行病学特征, 探讨超声心动图测定的相关指标与脓毒症患者预后的关系。方法采用病例对照研究方法, 收集2018年6月至2021年6月扬州大学附属江苏省苏北人民医院重症医学科和国家电网公司北京电力医院重症医学科收治的脓毒症患者的临床资料。记录患者一般情况和28 d预后;同时记录患者入重症监护病房(ICU)24 h内行经胸超声心动图检查获得的超声相关参数。比较28 d死亡组与存活组患者超声指标的差异, 并将有统计学意义的指标纳入Logistic回归分析, 筛选脓毒症患者预后的独立危险因素;通过受试者工作特征曲线(ROC曲线)评估超声指标对脓毒症患者预后的预测价值。结果共纳入符合标准的脓毒症患者145例, 其中脓毒性休克患者106例。145例患者中, 脓毒性心肌病73例, 发生率为50.3%;其中, 左室舒张功能障碍性心肌病发生率41.4%(60例), 左室收缩功能障碍性心肌病发生率24.8%(36例), 右室收缩功能障碍性心肌病发生率12.4%(18例)。28 d存活98例, 死亡47例, 病死率32.4%。与存活组相比, 死亡组超声指标二尖瓣侧壁瓣环处舒张早期峰值速度(e’’)和右室收缩期三尖瓣环运动速度(RV-Sm)均明显降低〔e’’(cm/s):7.81±1.12比8.61±1.02, RV-Sm(cm/s):12.12±2.04比13.73±1.74, 均P<0.05〕;死亡组左室射血分数(LVEF)和左室收缩期二尖瓣环运动速度(LV-Sm)略高于存活组〔LVEF:0.550±0.042比0.548±0.060, LV-Sm(cm/s):8.92±2.11比8.23±1.71〕, 差异无统计学意义(均P>0.05)。将两组间差异有统计学意义的指标纳入Logistic回归分析, 结果显示, e’’和RV-Sm均为影响脓毒症患者28 d预后的独立危险因素〔e’’:优势比(OR)=0.623, 95%可信区间(95%CI)为0.410~0.947, P=0.027;RV-Sm:OR=0.693, 95%CI为0.525~0.914, P=0.010〕。ROC曲线分析显示, e’’预测脓毒症患者28 d预后的ROC曲线下面积(AUC)为0.657, 95%CI为0.532~0.781, P=0.016;�Objective To investigate the epidemiological characteristics of septic cardiomyopathy and explore the relationship between the relevant indexes measured by echocardiography and the prognosis of patients with sepsis.Methods A case-control study was conducted.The data of patients with sepsis admitted to the department of critical care medicine of Jiangsu Subei People's Hospital Affiliated to Yangzhou University and the department of critical care medicine of Beijing Electric Power Hospital of State Grid Corporation of China from June 2018 to June 2021 were enrolled.The general information and 28-day prognosis were recorded.At the same time,ultrasonic parameters obtained by transthoracic echocardiography within 24 hours after intensive care unit(ICU)admission were recorded.The differences in ultrasound indexes between the death group and the survival group on 28 days were compared.Parameters with significant statistical differences between the death group and the survival group were included in the Logistic regression analysis to find the independent risk factors for the prognosis of patients with sepsis,the predictive value of each index for the prognosis of patients with sepsis was evaluated by receiver operator characteristic curve(ROC curve).Results A total of 145 patients with sepsis were enrolled,including 106 patients with septic shock.Among the 145 patients,septic cardiomyopathy was found in 73 patients,with the incidence of 50.3%.The incidence of left ventricular diastolic dysfunction cardiomyopathy was 41.4%(n=60),the incidence of left ventricular systolic dysfunction cardiomyopathy was 24.8%(n=36),and the incidence of right ventricular systolic dysfunction cardiomyopathy was 12.4%(n=18).At 28 days,98 patients survived and 47 died,with the mortality of 32.4%.The peak e'velocity by tissue Doppler imaging(e')and right ventricular myocardial systolic tricuspid annulus velocity(RV-Sm)of the death group were significantly lower than those of the survival group[e'(cm/s):7.81±1.12 vs.8.61±1.02,RV-Sm(cm/s):12.12

关 键 词：脓毒症 脓毒性心肌病 超声心动图 独立危险因素 预后 

分 类 号：R540.45[医药卫生—心血管疾病] R459.7[医药卫生—内科学]