摘要
目的探讨脓毒症心功能障碍患者血肌酐(Scr)、心肌肌钙蛋白I(cTnI)与超声心动图指标及其预后的关系。方法回顾性选择2019年8月至2022年1月绍兴第二医院收治的脓毒症患者164例,均于入院24 h内行Scr、cTnI水平检测和超声心动图检查。超声心动图指标包括左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心房内径(LAD)、左心室射血分数(LVEF)、每搏输出量(SV)、二尖瓣舒张早期充盈峰E峰流速与舒张晚期充盈峰A峰流速比值(E/A)、舒张早期二尖瓣峰流速与二尖瓣环运动速度比值(E/e')。采用Pearson相关分析Scr、cTnI水平与超声心动图各指标间的相关性。采用多因素logistic回归分析脓毒症心功能障碍患者28 d死亡的影响因素。采用ROC曲线分析Scr、cTnI水平单独及联合检测对预后预测的价值。结果收缩功能障碍者46例,舒张功能障碍者38例,心功能正常者80例。Pearson相关性分析显示,Scr、cTnI水平与脓毒症心功能障碍患者的LVEDd、LVESd、LAD、E/e'呈正相关(均P<0.05),与LVEF、SV、E/A呈负相关(均P<0.05)。随访28 d,84例心功能障碍患者中死亡49例(58.33%)。死亡组的Scr、cTnI水平及LVEDd、LVESd、LAD、E/e'高于存活组,LVEF、SV、E/A低于存活组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,年龄、LVEDd、LVESd、LAD、LVEF、SV、E/A、E/e'及Scr、cTnI水平均是心功能障碍患者28d死亡的影响因素(均P<0.05)。ROC曲线结果显示,Scr、cTnI联合评估心功能障碍患者28 d死亡的AUC高于各单独检测(均P<0.05)。结论脓毒症心功能障碍患者Scr、cTnI水平与超声心动图参数及近期预后相关。
Objective To investigate the association of serum creatinine(Scr)and cardiac troponin I(cTnI)with echocardiographic parameters and prognosis of patients with sepsis-induced cardiac dysfunction.Methods A total of 164 patients with sepsis treated in Shaoxing Second Hospital from August 2019 to January 2022 were enrolled.Scr and cTnI were measured and echocardiography was performed within 24 h after admission.Echocardiographic para-meters included left ventricular end diastolic diameter(LVEDd),left ventricular end systolic diameter(LVESd),left atrial diameter(LAD),left ventricular ejection fraction(LVEF),stroke volume(SV),ratio of peak E velocity of early diastolic filling peak to peak A velocity of late diastolic filling peak(E/A)and ratio of peak velocity of mitral valve in early diastole to motion velocity of mitral annulus in early diastole(E/e').Pearson correlation analysis was used to analyze the correlation between Scr and cTnI and echocardiographic indexes.Multivariate logistic regression analysis was used to determine the risk factors for 28-day mortality of patients with sepsis-induced cardiac dysfunction.The value of single and combination of Scr and cTnI for predicting outcomes was analyzed using receiver operating characteristic(ROC)curve.Results There were 46 cases with cardiac systolic dysfunction,38 cases with cardiac diastolic dysfunction and 80 cases with normal cardiac function.Pearson correlation analysis showed that Scr and cTnI were positively correlated with LVEDd,LVESd,LAD and E/e'in patients with sepsis-induced cardiac dysfunction(all P<0.05),but negatively correlated with LVEF,SV and E/A(all P<0.05).During 28-day of follow-up,49 patients died(58.33%)among 84 patients with cardiac dysfunction.Scr,cTnI,LVEDd,LVESd,LAD and E/e'in the death group were significantly higher than those in the survival group,while LVEF,SV and E/A were significantly lower than those in the survival group(all P<0.05).Multivariate logistic regression analysis showed that age,LVEDd,LVESd,LAD,LVEF,SV,E/A,E/e',Scr and cT
作者
崔艳飞
陆芹芹
黄兰芳
CUI Yanfei;LU Qinqin;HUANG Lanfang(ICU,Shaoxing Second Hospital,Shaoxing 312099,China)
出处
《心电与循环》
2024年第6期589-593,602,共6页
Journal of Electrocardiology and Circulation
关键词
血肌酐
肌钙蛋白Ⅰ
脓毒症
心功能障碍
预后
Serum creatinine
Cardiac troponin I
Sepsis
Cardiac dysfunction
Prognosis
