作者：庄燕，张海东，戴林峰，陈秋华，王建

单位：

210029江苏省南京市，南京中医药大学附属医院重症医学科 通信作者：庄燕，E-mail：athena2004112@163.com

Units：

Department of Critical Care Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China Corresponding author: ZHUANG Yan, E-mail: athena2004112@163.com

关键词：

脓毒症; 脓毒症心肌功能障碍; 影响因素分析; 预测价值;

Keywords：

Sepsis; Sepsis-induced myocardial dysfunction; Root cause analysis; Predictive value

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.291

Funds：

江苏省中医药科技发展计划项目（MS2021008）；全国西学中骨干人才培训项目（〔2019〕44）

摘要：

目的 探讨脓毒症心肌功能障碍(SIMD)及其预后影响因素。方法 回顾性选取2019年6月至2020年12月南京中医药大学附属医院重症医学科收治的脓毒症患者102例。根据是否发生SIMD将患者分为SIMD组和非SIMD组。比较SIMD组和非SIMD组患者临床资料〔性别、年龄，高血压、冠心病、糖尿病、慢性肾脏病(CKD)、慢性阻塞性肺疾病(COPD)发生情况，入院时平均动脉压(MAP)、心率(HR)、氧合指数(OI)、血乳酸(Lac)、血肌酐(Scr)、WBC、降钙素原(PCT)、B型利钠肽(BNP)、肌酸激酶同工酶(CK-MB)、急性生理学与慢性健康状况Ⅱ(APACHE Ⅱ)评分、序贯器官衰竭评估(SOFA)评分、ICU住院时间、28 d生存情况〕。根据28 d死亡情况，将SIMD患者分为存活亚组和死亡亚组，比较存活亚组和死亡亚组患者临床资料。采用多因素Logistic回归分析探讨脓毒症患者发生SIMD的影响因素及SIMD患者28 d死亡的影响因素，并绘制ROC曲线以评估影响因素对脓毒症患者发生SIMD及SIMD患者28 d死亡风险的预测价值。结果 102例患者中有45例发生SIMD，SIMD发生率为44.1%。SIMD组患者Scr、BNP、APACHE Ⅱ评分、SOFA评分高于非SIMD组(P<0.05)。多因素Logistic回归分析结果显示，年龄、HR、BNP及SOFA评分是脓毒症患者发生SIMD的影响因素(P<0.05)。年龄、HR、BNP、SOFA评分及四者联合预测脓毒症患者发生SIMD的AUC分别为0.608、0.576、0.649、0.681及0.770。45例SIMD患者中16例28 d内死亡。存活亚组患者年龄、BNP、SOFA评分低于死亡亚组，MAP高于死亡亚组(P<0.05)。多因素Logistic回归分析结果显示，SOFA评分是SIMD患者28 d死亡的影响因素(P<0.05)。SOFA评分预测SIMD 患者28 d死亡风险的AUC为0.704。结论 脓毒症患者SIMD发生率较高。年龄增大和HR增快及BNP、SOFA评分升高是脓毒症患者发生SIMD的危险因素，且SOFA评分升高是SIMD患者28 d死亡的危险因素。

Abstract：

【Abstract】 Objective To investigate the influencing factors of sepsis-induced myocardial dysfunction (SIMD) and its prognosis. Methods A total of 102 sepsis patients admitted to the Department of Critical Care Medicine of Affiliated Hospital of Nanjing University of Chinese Medicine from June 2019 to December 2020 were retrospectively selected. Patients were divided into SIMD group and non-SIMD group according to the occurrence of SIMD. The clinical data [gender, age and the occurrence of hypertension, coronary heart disease, diabetes, chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) , mean arterial pressure (MAP) , heart rate (HR) , oxygenation index (OI) , lactate (Lac) , serum creatinine (Scr) , WBC, procalcitonin (PCT) , B-type natriuretic peptide (BNP) , creatine kinase isoenzyme (CK-MB) , Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, ICU length of stay, 28-day survival condition] were compared between the SIMD group and non-SIMD group. Patients with SIMD were divided into survival subgroup and death subgroup according to the death of 28 days, and the clinical data were compared between the survival subgroup and death subgroup. Multivariate Logistic regression analysis was used to explore the influencing factors of SIMD in sepsis patients and 28-day death in SIMD patients, and the ROC curve was plotted to assess the predictive value of the influencing factors for SIMD in sepsis patients and 28-day death in SIMD patients. Results SIMD occurred in 45 of 102 patients, and its incidence rate was 44.1%. Scr, BNP, APACHE Ⅱ scores and SOFA scores in the SIMD group were higher than those in the non-SIMD group (P < 0.05) . Multivariate Logistic regression analysis showed that age, HR, BNP and SOFA score were the influencing factors of SIMD in patients with sepsis (P < 0.05) . The AUC of age, HR, BNP, SOFA scores and their combination in predicting SIMD in sepsis patients were 0.608, 0.576, 0.649, 0.681 and 0.770, respectively. Sixteen of 45 SIMD patients died in 28 days. Age, BNP and SOFA score of patients in the survival subgroup were lower than those in the death subgroup, and MAP was higher than that in the death subgroup (P < 0.05) . Multivariate Logistic regression analysis showed that SOFA score was an influencing factor of 28-day death in SIMD patients ( P < 0.05) . The AUC of SOFA score for predicting 28-day death risk in SIMD patients was 0.704. Conclusion SIMD occurs more frequently in patients with sepsis. Increased age, HR, BNP and SOFA score were risk factors for SIMD in patients with sepsis, and increased SOFA scores was a risk factor for 28-day death in SIMD patients.

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