脓毒症患者心率减速力改变与临床预后的相关性研究
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摘要
目的:探讨脓毒症患者心率减速力(DC)改变与临床预后的相关性。方法:连续性纳入2014-01-2016-06我院收治的脓毒症患者124例,根据患者28d病死率分为死亡组(n=52)和存活组(n=72)。所有患者入组后进行急性生理和慢性健康(APACHE)Ⅱ和SOFA评分,给予动态心电图检测并计算DC值。结果:死亡组患者APACHEⅡ评分和SOFA评分明显高于存活组[(38.2±9.3)分vs.(27.2±6.1)分,P<0.05;(13.2±3.2)分vs.(8.1±2.3)分,P<0.05)],而DC明显低于存活组[(2.8±0.5)ms vs.(4.2±0.8)ms,P<0.05]。DC降低组患者ICU滞留时间和28d病死率明显高于DC正常组[(14.2±2.5)d vs.(10.3±3.1)d,P<0.05;55.3%vs.33.8%,P<0.05)]。DC预警28d死亡事件的AUC为0.832,95%CI为0.723~0.872,cut-off值为2.2ms,特异性为84.2%,敏感性为80.1%。DC水平与28d病死率(r=-0.611,P<0.05)和ICU滞留时间(r=-0.531,P<0.05)呈负相关。结论:DC水平降低与脓毒症患者病死率密切相关,是潜在的评价临床预后的预警指标。
Objective:To evaluate the relation of deceleration capacity(DC)and clinical prognosis in patients with sepsis-induced myocardial dysfunction(SIMD).Method:One hundred and twenty-four sepsis patients were enroll in this study and divided into two groups based on 28-day mortality:Death group(n=52)and survival group(n=72).All the patients were evaluated by APACHE Ⅱ and SOFA scores.DC value was calculated based on dynamic electrocardiogram.Result:The levels of APACHE Ⅱ and SOFA in death group were higher than those in survival group[(38.2±9.3)vs.(27.2±6.1),P<0.05;(13.2±3.2)vs.(8.1±2.3),P<0.05)],while DC levels were lower than those in survival group[(2.8±0.5)ms vs.(4.2±0.8)ms,P<0.05].ROC analysis showed that the AUC of DC for SIMD early warming was 0.832 and cut-off value was 2.2ms with 84.2%sensitivity and80.1% specificity.Correlation analysis showed that DC was negatively associated with 28-day mortality(r=-0.611,P<0.05)and ICU hospital days(r=-0.531,P<0.05).Conclusion:The decrease of DC is associated with mortality of sepsis patients,which may be a potential early warming marker for clinical prognosis prediction.
Objective:To evaluate the relation of deceleration capacity(DC)and clinical prognosis in patients with sepsis-induced myocardial dysfunction(SIMD).Method:One hundred and twenty-four sepsis patients were enroll in this study and divided into two groups based on 28-day mortality:Death group(n=52)and survival group(n=72).All the patients were evaluated by APACHE Ⅱ and SOFA scores.DC value was calculated based on dynamic electrocardiogram.Result:The levels of APACHE Ⅱ and SOFA in death group were higher than those in survival group[(38.2±9.3)vs.(27.2±6.1),P<0.05;(13.2±3.2)vs.(8.1±2.3),P<0.05)],while DC levels were lower than those in survival group[(2.8±0.5)ms vs.(4.2±0.8)ms,P<0.05].ROC analysis showed that the AUC of DC for SIMD early warming was 0.832 and cut-off value was 2.2ms with 84.2%sensitivity and80.1% specificity.Correlation analysis showed that DC was negatively associated with 28-day mortality(r=-0.611,P<0.05)and ICU hospital days(r=-0.531,P<0.05).Conclusion:The decrease of DC is associated with mortality of sepsis patients,which may be a potential early warming marker for clinical prognosis prediction.
引文
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[17]王晶晶,杨敬平,齐明禄.TLR4介导的信号通路与脓毒症相关性研究[J].临床肺科杂志,2015,19(4):725-727.
[18]An R,Zhao L,Xi C,et al.Melatonin attenuates sepsisinduced cardiac dysfunction via a PI3K/Akt-dependent mechanism[J].Basic Res Cardiol,2016,111(1):1-15.
[19]陈勇,童希忠,梁应平,等.颈交感神经干离断对脓毒症大鼠凝血和纤溶功能的影响[J].临床麻醉学杂志,2015,31(9):908-911.
[2]Deis A,Whiles B,Simpson S.SIRS vs qSofa at presentation in patients with diagnosed severe sepsis and septic shock[J].Chest,2016,150(4):348A-348A.
[3]李真玉,陈兵,李广平.脓毒症心肌抑制的诊治进展[J].中国循环杂志,2015,24(7):567-571.
[4]张燕,夏云龙.心率减速力研究新进展[J].临床心血管病杂志,2015,19(1):13-16.
[5]中国中西医结合学会急救医学专业委员会.脓毒症中西医结合诊治专家共识[J].中华危重病急救医学,2013,25(4):194-197.
[6]郭继鸿.心率减速力检测[J].临床心电学杂志,2009,18(1):59-68.
[7]Park M,Vos P,Vlaskamp B N,et al.The influence of APACHEⅡscore on the average noise level in an intensive care unit:an observational study[J].BMC Anesthesiol,2015,15(1):1-9.
[8]Rheinlnder A,Heise A,Hueske F,et al.SOFA:An extensible logical optimizer for UDF-heavy data flows[J].Information Systems,2015,52:96-125.
[9]唐高骏,何依婷,简立建.全身性感染新定义:有助于ICU外的医护人员快速筛选出脓毒症患者[J].中华重症医学电子杂志,2016,2(3):491-493
[10]Fleischmann C,Scherag A,Adhikari N K,et al.Assessment of global incidence and mortality of hospitaltreated sepsis-current estimates and limitations[J].Am J Respir Crit Care Med,2015,193(3):259-272.
[11]Jolley R J,Sawka K J,Yergens D W,et al.Validity of administrative data in recording sepsis:a systematic review[J].Crit Care,2015,19(1):1-12.
[12]Clemente G,Tuttolomondo A,Colomba D,et al.When sepsis affects the heart:A case report and literature review[J].World J Clin Cases,2015,3(8):743-750.
[13]Taylor S.A review of equine sepsis[J].Equine Vet Educ,2015,27(2):99-109.
[14]王军,蒋炳林,朱海龙,等.重症脓毒症和脓毒症休克患者心脏损伤指标的临床价值[J].医学综述,2015,21(19):3594-3596.
[15]Gao F,Yang Y Z,Feng X Y,et al.Interleukin-27is elevated in sepsis-induced myocardial dysfunction and mediates inflammation.[J].Cytokine,2016,88(7):1-11.
[16]李国民,唐云,卢朝辉,等.NRG1-ErbB4信号通路在脓毒症大鼠心肌功能障碍中的作用[J].江苏医药,2016,42(3):262-265.
[17]王晶晶,杨敬平,齐明禄.TLR4介导的信号通路与脓毒症相关性研究[J].临床肺科杂志,2015,19(4):725-727.
[18]An R,Zhao L,Xi C,et al.Melatonin attenuates sepsisinduced cardiac dysfunction via a PI3K/Akt-dependent mechanism[J].Basic Res Cardiol,2016,111(1):1-15.
[19]陈勇,童希忠,梁应平,等.颈交感神经干离断对脓毒症大鼠凝血和纤溶功能的影响[J].临床麻醉学杂志,2015,31(9):908-911.