急性重症感染后炎症细胞因子风暴下心肌状态及超声心动图心脏检测的价值

Myocardial status under inflammatory cytokine storm after acute severe infection and the value of echocardiography in heart detection

摘要:

目的 探讨急性重症感染后炎症细胞因子风暴下的心肌状态及超声心动图心脏检测的价值。方法 选取2020年1月—2023年2月在海南西部中心医院就诊的急性重症感染患者110例，其中，合并细胞因子风暴患者45例（观察组），无细胞因子风暴患者65例（对照组）。比较两组患者的临床资料、心肌损伤标志物、心电图、超声心动图参数等差异。结果 观察组患者年龄高于对照组（P <0.05）；观察组乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶、肌钙蛋白T、肌钙蛋白I和N-末端B型脑钠肽原高于对照组（P <0.05）；观察组白细胞计数和中性粒细胞计数高于对照组（P <0.05），而血小板计数和红细胞计数低于对照组（P <0.05）；观察组心房颤动、室性期前收缩、房性期前收缩和异常Q波占比高于对照组（P <0.05）；观察组左心室舒张末期内径、左心室收缩末期内径、左心室舒张末期容积、左心室收缩末期容积、E峰、三尖瓣反流压差和肺动脉收缩压高于对照组（P <0.05），而左室射血分数和A峰低于对照组（P <0.05）。结论 急性重症感染后炎症细胞因子风暴下患者心肌损伤明显，超声心动图可直观检测心脏情况。

关键词:急性重症感染;细胞因子风暴;超声心动图;心肌损伤

Abstract:

Objective To investigate the myocardial status and the value of echocardiography in the detection of cardiac function in patients with acute severe infection under the storm of inflammatory cytokines.Methods A total of 110 patients with acute severe infection treated at the Western Center Hospital in Hainan from January 2020 to February 2023 were selected. Among them, 45 patients with cytokine storm were included in the observation group, and 65 patients without cytokine storm were included in the control group. The differences in clinical data, myocardial injury markers, electrocardiogram, and echocardiographic parameters between the two groups were compared.Results Patients in the observation group were older than those in the control group (P < 0.05). Lactate dehydrogenase, creatine kinase, creatine kinase isoenzyme, cardiac troponin T, cardiac troponin I, and N-terminal pro-brain natriuretic peptide in the observation group were higher than those in the control group (P < 0.05). White blood cell count and neutrophil count in the observation group were higher than those in the control group (P < 0.05), while platelet count and red blood cell count were lower than those in the control group (P < 0.05). The proportion of atrial fibrillation, ventricular premature contraction, atrial premature contraction, and abnormal Q wave in the observation group was higher than that in the control group (P < 0.05). Left ventricular end-diastolic diameter , left ventricular end-systolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume , E peak, tricuspid regurgitation pressure gradient, and pulmonary artery systolic pressure in the observation group were higher than those in the control group (P < 0.05), while left ventricular ejection fraction and A peak were lower than those in the control group (P < 0.05). Conclusion Myocardial injury is evident in patients with acute severe infection under the storm of inflammatory cytokines, and echocardiography can visually detect the cardiac condition.

Key words:acute severe infection;cytokine storm;echocardiography;myocardial damage