摘要
目的探讨脓毒症心肌病患者心率减速力(deceleration capacity of rate,DC)的变化及临床意义。方法纳入2015年1月—2016年6月我院急诊重症监护病房收治的脓毒症患者66例,根据是否出现脓毒症导致的心肌功能障碍(sepsis-induced myocardial dysfunction,SIMD)分为SIMD组38例和非SIMD组28例,分析比较两组入组时及SIMD组诊断时N末端B型脑钠肽前体(NT-pro BNP)、肌钙蛋白I(c Tn I)、左室舒张末期内径(LVEDD)、左房收缩末期内径(LASD)、左室射血分数(LVEF)和二尖瓣口舒张期血流流速E/A峰比值;绘制受试者工作特征(receiver operator characteristic,ROC)曲线分析DC诊断脓毒症心肌病的效能,分析DC与脓毒症心肌病的相关性。结果 SIMD组自发病至出现心功能不全症状时间为3~7(4.4±1.2)d。两组入组时NT-pro BNP、c Tn I、LVEDD、LASD、LVEF和E/A水平比较差异均无统计学意义(P>0.05);SIMD组DC水平为(2.1±0.2)s明显低于非SIMD组的(5.3±0.5)s(P<0.01)。较入组时,SIMD组诊断时NT-pro BNP水平明显升高,LASD、LVEF和E/A水平均明显下降(P<0.05或P<0.01)。ROC曲线分析显示,DC预警SIMD的曲线下面积为0.835,95%CI为0.756,0.877,截断值为1.8 ms,特异性为85.3%,敏感性为82.9%。Pearson和Spearman相关性分析显示,SIMD组患者入组时DC水平与SIMD发生和28 d病死率呈负相关(r=-0.698,P=0.001;r=-0.634,P=0.002)。结论 DC是较为可靠的SIMD早期预警指标,与SIMD患者临床预后存在一定的相关性。
Objective To investigate change and clinical significance of deceleration capacity of rate （DC） in patients with sepsis-induced myocardial dysfunction （SIMD）.Methods A total of 66 sepsis patients admitted during January 2015 and June 2016 were divided into SIMD group （n=38） and non-SIMD group （n=28） according to whether or not having SIMD.Values of N-terminal-pro-B-type natriuretic peptide （NT-proBNP）, troponin I （cTnI）, left ventricular end-diastolic dimension （LVEDD）, left atrial end systolic diameter （LASD）, left ventricular ejection fraction （LVEF） and E/A blood flow rate of mitral orifice diastolic period were analyzed and compared at the time of entering groups and at the time of confirming SIMD in two groups.Receiver operating curve （ROC） was drawn to analyze diagnostic effect of DC for SIMD, and the correlation between DC and SIMD was also analyzed.Results The time from onset to having syndrome of cardiac dysfunction was 3-7 （4.4±1.2）d in SIMD group.There were no significant differences in values of NT-proBNP, cTnI, LVEDD, LASD, LVEF and E/A in two groups at the time of entering groups （P〉0.05）.DC level in SIMD group [（2.1±0.2）s] was significantly lower than（5.3±0.5）s in non-SIMD group （P〈0.01）.In SIMD group, at the time of confirming SIMD, NT-proBNP value was significantly increased, while LASD, LVEF and E/A values were significantly decreased compared with those at the time of entering groups （P〈0.05 or P〈0.01）.ROC analysis showed that area under curve of DC in early precaution of SIMD was 0.835;95% CI was 0.756,0.877;cut-off value was 1.8 ms;sensitivity was 85.3%, and specificity was 82.9%.Correlation analysis of Pearson and Spearman showed that DC was negatively associated with SIMD onset and 28-day mortality （r=-0.698, P=0.001;r=-0.634, P=0.002）.Conclusion DC may be a reliable index in early precaution of SIMD, and it has a certain correlation with clinical prognosis in SIMD patients.
出处
《临床误诊误治》
2017年第7期79-82,共4页
Clinical Misdiagnosis & Mistherapy
关键词
心率减速力
脓毒症
心肌疾病
并发症
Deceleration capacity
Sepsis
Cardiomyopathies
Complications
