严重脓毒症患者主要不良心脏事件的危险因素分析

摘要

Objective To investigate the risk factors of major adverse cardiac events in patients with severe sepsis.Methods Totally 148 patients with severe sepsis in intensive care unit (ICU) from January 2013 to July 2015 was retrospectively analyzed.The medical history,infection indicators,biochemical indexes,life indication and myocardial injury within 24 h after admission in ICU were recorded;the risk factors of major adverse cardiac events were analyzed by Logistic regression.Results The incidence of major adverse cardiac events in hospital was 34.5％ (51/148),the mortality in hospital was 33.1％ (49/148).Logistic regression analysis showed that the risk factors of major adverse cardiac events in patients with severe sepsis included rise of cardiac troponin Ⅰ immediately after admission in ICU (OR=3.90,95％ CI:1.75-8.66,P=0.001) and higher acute physiology and chronic health evaluation (APACHE) Ⅱ score within 24 h after admission in ICU (OR =1.07,95％ CI:1.01-1.14,P =0.035).Conclusions The incidence of major adverse cardiac events in patients with severe sepsis is high;rise of cardiac troponin Ⅰ immediately after admission in ICU and higher APACHE Ⅱ score with in 24 h after admission in ICU are independent risk factors of major adverse cardiac events in patients with severe sepsis.%目的 探讨严重脓毒症患者主要不良心脏事件的危险因素.方法 回顾性分析2013年1月至2015年7月北京大学人民医院重症监护病房收治的严重脓毒症患者148例.记录病史、感染指标、生化指标、入室24 h内生命指征及心肌损伤情况;采用Logistic回归分析评估严重脓毒症患者主要不良心脏事件危险因素.结果 严重脓毒症患者院内主要不良心脏事件发生率为34.5％(51/148),院内死亡率为33.1％ (49/148).Logistic回归分析表明入室即刻心脏肌钙蛋白Ⅰ升高[比值比(OR)=3.90,95％置信区间(CI):1.75 ～8.66,P=0.001)和入室24 h内高急性生理和慢性健康状况(APACHE)Ⅱ评分(OR=1.07,95％ CI:1.01 ～ 1.14,P=0.035)是严重脓毒症患者发生主要不良心脏事件的独立危险因素.结论 严重脓毒症患者的主要不良心脏事件的发生率高,入室即刻心脏肌钙蛋白Ⅰ升高和入室24 h内高APACHEⅡ评分是严重脓毒症患者发生主要不良心脏事件的独立危险因素.