脓毒症心肌损伤后心脏舒缩功能的动态变化

Dynamic changes of cardiac systolic and diastolic function after myocardial injury in patients with sepsis

摘要:

目的 探讨心脏舒张、收缩功能和心肌损伤指标对脓毒症患者动态变化和预后判断的作用。 方法 收集脓毒症患者70 例。根据28 d 的预后分为生存组和死亡组。分别于入重症医学科（ICU）第1 和3 天应用床旁心脏超声测量二尖瓣舒张早期充盈峰速度E 峰（E）与舒张晚期充盈峰速度A 峰（A）、二 尖瓣环舒张早期速度（e’）的比值，将E/e’及E/A 作为评估左心室舒张功能的指标；测量左心室射血分 数（LVEF）作为评估左心室收缩功能的指标。监测第1 和3 天心肌损伤标志物肌钙蛋白（cTnI）及肌酸激 酶同工酶（CK-MB）水平。通过Logistic 回归方法，对可能影响脓毒症预后的危险因素进行分析。结果 两 组患者于入ICU 第3 天的E/e’高于第1 天（P <0.05），LVEF 低于第1 天（P <0.05）；死亡组第1 和3 天 的E/e’高于生存组（P <0.05）。两组第3 天的cTnI、CK-MB 高于第1 天（P <0.05），死亡组第3 天的 cTnI 高于生存组（P <0.05）。Logistic 回归分析显示，E/e’[Ol ^ R=1.534，（95% CI ：1.116，1.982），P =0.003]、 cTnI[Ol ^ R=1.120，（95% CI ：0.907，1.432），P =0.039] 是影响脓毒症患者28 d 预后的危险因素。结论 脓毒症 患者存在心肌损伤，心脏舒张及收缩功能发生了动态变化，且高死亡风险脓毒症患者心脏舒缩功能及心肌损 伤明显加重。E/e’、cTnI 能预测脓毒症患者的预后。

Abstract:

Objective To investigate dynamic changes of diastolic and systolic functions of cardiac and myocardial injury markers in patients with sepsis and risk factors which could affect prognosis. Methods Totally 70 patients with sepsis were divided into survival group and death group according to 28-day mortality. Patients in ICU underwent echocardiogram to measure velocities of early diastolic filling wave (E), late filling wave (A) and early diastolic velocity of the mitral annulus (e’) on the 1st day and 3rd day. E/e’ and E/A were used to evaluate left ventricular diastolic function. Left ventricular ejection fraction (LVEF) was measured as evaluation index of left ventricular systolic function on the 1st day and 3rd day, meanwhile levels of cardiac troponin (cTnI) and creatine kinase isoenzyme (CK-MB) were monitored. Logistic regression was used to analysis risk factors which could affect prognosis. Results Compared with data on the 1st day, E/e’ increased and LVEF decreased on the 3rd day in both groups (P < 0.05). Compared with survival group, E/e’ is higher on the 1st day and 3rd day in death group (P < 0.05); in addition, the levels of cTnI and CK-MB on the 3rd day were higher than those on the 1st day (P < 0.05), and the levels of cTnI on the 3rd day in the death group were higher than those in the survival group (P < 0.05). Logistic regression analysis showed that E/e’ (Ol ^ R=1.534, (95% CI: 1.116, 1.982), P = 0.003) and cTnI (Ol ^ R =1.120, (95% CI: 0.907, 1.432), P = 0.039) were risk factors which could affect prognosis of sepsis. Conclusions Dynamic changes of cardiac systolic, diastolic function and myocardial injury are found in patients with sepsis. Cardiac function and myocardial injury are significantly aggravated in patients with high risk of death. E/e’ and cTnI have predictive value which could be beneficial to evaluate the prognosis of patients with sepsis.