脓毒血症伴心脏变时性功能不全对预后的影响

摘要

目的 探讨脓毒血症伴心脏变时性功能不全(chronotropic incompetence,CI)的临床特点及预后.方法 2010年7月1日～2011年1月5日我院ICU收治脓毒血症164例,将其中伴CI的26例设为CI组,不伴CI者设为非CI组,通过24 h床边实时动态心电监测记录患者ICU住院期间每日最高心率、静息心率,并计算运动峰值心率与预测最大心率值之比(rHR),观察两组C反应蛋白(CRP)、肌酸激酶同工酶(CK-MB)水平及休克发生率、病死率.结果 CI组峰值心率、静息心率、rHR均显著低于非CI组(P＜0.01),休克发生率和病死率均高于非CI组(P＜0.01和＜0.05),两组CRP、CK-MB比较差异无统计学意义(P＞0.05).结论 根据动态心电监护记录的心率值变化可以进行CI诊断.脓毒血症患者伴有CI时可导致循环不稳定,预后较差,应引起重视.%Objective To investigate the clinical characteristics and prognosis of chronotropic incompetence (CI) in patients with pyemia. Methods 164 patients with pyemia were admitted to ICU wards during July 2010 and January 2011 ,among whom, 26 with CI were regarded as CI group(n =26), but those without CI were regarded as non-CI group. During hospitalization in ICU, their daily peak heart rate and resting heart rate were monitored by 24-hour dynamic electrocardiography.The ratio between peak exercise heart rate and predictive maximum heart rate was counted. The levels of C-reactive protein (CRP), MB isoenzyme of creatine kinase (CK-MB) and the incidence of shock and fatality were observed. Results Ratio between peak exercise heart rate and predictive maximum heart rate, peak heart rate, and reasting heart rate in CI group were significantly lower than those in Non- CI group(P ＜0.01 ), and the incidence rate of shock and fatality rate in CI group were significantly higher than those in Non-CI group (P ＜0.01, P ＜0.05), but there was no significant difference in CRP and CK-MB between the two groups(P ＞ 0.05). Conclusion CI could be diagnosed by the parameter of heart rate obtained from dynamic electrocardiography. It should be noted that CI can contribute to unstable circulation and poor prognosis in patients with pyemia.