摘要
目的探讨心肌损伤对重症医学科(ICU)脓毒症患者的影响及其危险因素分析。方法选择2019年9月至2022年8月就诊于首都医科大学附属北京中医医院ICU并明确诊断为脓毒症的患者为研究对象,根据患者是否存在心肌损伤分为观察组(脓毒症合并心肌损伤)和对照组(脓毒症不合并心肌损伤),收集患者临床资料并比较分析心肌损伤对患者的影响及其危险因素。结果本研究共纳入120例经Sepsis 3.0诊断标准明确诊断为脓毒症的患者,其中观察组70例,对照组50例。结果显示两组患者在性别、年龄方面差异无明显统计学意义(P>0.05)。既往病史方面,观察组患者心房颤动病史率(P=0.003)、心肌梗死病史率(P=0.001)和心力衰竭病史率(P<0.001)均显著高于对照组。在实验室指标方面,观察组患者心肌酶水平,包括肌钙蛋白水平[(1.45±0.62)ng/ml vs.(0.05±0.01)ng/ml,P<0.001]、肌酸激酶同工酶水平[(6.03±3.19)ng/ml vs.(1.50±0.01)ng/ml,P<0.001]、肌红蛋白水平(P<0.001)和肌酸激酶水平(P<0.001)均显著高于对照组。观察组患者感染指标,包括白细胞水平[(20.17±7.18)×10^(9)vs.(14.19±0.01)×10^(9),P<0.001]、C反应蛋白水平[(351.88±70.61)mg/L vs.(58.10±0.00)mg/L,P<0.001]和降钙素原水平(P<0.001)均显著高于对照组。在心脏超声参数方面,观察组患者左房前后径显著大于对照组[(34.58±3.59)mm vs.(30.00±0.01)mm,P<0.001[,左室射血分数(LVEF)显著低于对照组[(56.96±5.50)%vs.(66.00±0.01)%,P<0.001]。在临床预后方面,观察组患者院内总死亡率显著高于对照组(54.29%vs.36.00%,P=0.048),但ICU死亡率、28 d死亡率、ICU住院时间和院内总住院时间与对照组相似,差异均无统计学意义(P>0.05)。回归分析结果显示肌钙蛋白水平(r=84.812,P=0.014)、肌酸激酶同工酶水平(r=0.661,P=0.017)、肌酸激酶水平(r=0.01,P=0.027)和左房前后径(r=0.327,P=0.015)均与脓毒症心肌损伤的发生呈显著正相关,血小板水�
Objective To discuss the influence of myocardial injury on patients with sepsis in ICU,and analyze the risk factors.Methods The patients with sepsis were chosen as research objects from ICU in Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University from Sept.2019 to Aug.2022.All patients were divided,according to whether they had myocardial injury or not,into observation group(with myocardial injury complicated by sepsis)and control group(with only sepsis).Clinical materials were collected,and influence and risk factors of myocardial injury were analyzed in the patients with sepsis.Results There were totally 120 patients diagnosed with sepsis by using criterion of Sepsis 3.0 enrolled in this study,and 70 in observation group and 50 in control group.The statistic results showed that there were no significant differences in gender and age between 2 groups(P>0.05).In terms of past medical history,the incidence rates of atrial fibrillation(P=0.003),myocardial infarction(P=0.001)and heart failure(P<0.001)were significantly higher in observation group than those in control group.In terms of laboratory indexes,the levels of myocardial enzymes,including troponin[(1.45±0.62)ng/ml vs.(0.05±0.01)ng/ml,P<0.001],creatine kinase-MB isoenzyme[CK-MB,(6.03±3.19)ng/ml vs.(1.50±0.01)ng/ml,P<0.001],myoglobin(Mb,P<0.001)and creatine kinase(CK,P<0.001)were all significantly higher in observation group than those in control group.The infection indicators,including white blood cell level[(20.17±7.18)×10^(9)vs.(14.19±0.01)×10^(9),P<0.001],C-reactive protein level[CRP,(351.88±70.61)mg/L vs.(58.10±0.00)mg/L,P<0.001]and procalcitonin(PCT,P<0.001)were significantly higher in observation group than those in control group.In terms of cardiac ultrasound parameters,left atrial anteroposterior diameter(LAAPD)was significantly larger[(34.58±3.59)mm vs.(30.00±0.01)mm,P<0.001],and left ventricular ejection fraction(LVEF)was significantly lower[(56.96±5.50)%vs.(66.00±0.01)%,P<0.001]in observation group
作者
朱玉菡
陈腾飞
宋麦芬
刘艳艳
Zhu Yuhan;Chen Tengfei;Song Maifen;Liu Yanyan(Intensive Care Unit,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;不详)
出处
《中国循证心血管医学杂志》
2023年第3期336-340,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
关键词
心肌损伤
脓毒症
心肌酶
心脏超声
Myocardial injury
Sepsis
Myocardial enzymes
Echocardiography
