Heart:脓毒症休克患者右心室功能障碍与预后不良之间的关联

2020-07-10 MedSci原创 MedSci原创

三分之一的脓毒性休克患者表现出各种心肌功能障碍。左室收缩功能不全较为常见。然而,只有RV功能障碍与短期死亡率有关。

脓毒症引起的心肌功能障碍(SIMD)可以累及左右心室。但是,SIMD各种表现形式的特征和结局仍然未知。

近日,心脏病领域权威杂志Heart上发表了一篇研究文章,这是一项回顾性队列研究使用了2011年1月至2017年4月期间败血性休克前瞻性登记中心的数据。入院后72小时内研究人员对临床上​推测为心脏功能障碍的患者进行了超声心动图检查,并招募入组(n=778)。SIMD分为左心室(LV)收缩/舒张功能障碍和右心室(RV)功能障碍,这是根据美国超声心动图学会标准定义的。该研究的主要结局为28天死亡率。

778名接受超声心动图检查的败血性休克患者中,有270名(34.7%)表现为SIMD。中位年龄为67.0岁,其中男性占主导地位(57.3%)。其中,LV收缩功能障碍占67.3%,RV收缩功能障碍占40.7%,LV舒张功能障碍占39.3%。尽管两组之间的血清乳酸水平和顺序器官衰竭评估得分没有显著差异,但SIMD组具有出较高的肌钙蛋白I(0.1 vs 0.1 ng/mL;p=0.02)和较差的临床结局,包括较高的28天死亡率(35.9 vs 26.8%;p<0.01),重症监护病房住院时间更长(5 vs 2天;p<0.01)和延长的机械通气时间(9 vs 4天;p<0.01)。多变量分析表明,孤立的RV功能障碍是28天死亡率的独立危险因素(OR为2.26,95%CI为1.04至4.91)。

由此可见,三分之一的脓毒性休克患者表现出各种心肌功能障碍。左室收缩功能不全较为常见。然而,只有RV功能障碍与短期死亡率有关。

原始出处:

June-sung Kim.et al.Association between right ventricle dysfunction and poor outcome in patients with septic shock.heart.2020.https://heart.bmj.com/content/early/2020/07/08/heartjnl-2020-316889

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    2020-07-12 zhaojie88
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  5. 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createdBy=8d285168486, createdName=77665544332211, createdTime=Fri Jul 10 19:14:01 CST 2020, time=2020-07-10, status=1, ipAttribution=)]
  6. 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createdBy=8d285168486, createdName=77665544332211, createdTime=Fri Jul 10 19:14:01 CST 2020, time=2020-07-10, status=1, ipAttribution=)]
  7. 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GetPortalCommentsPageByObjectIdResponse(id=1577050, encodeId=a3e115e705079, content=<a href='/topic/show?id=e9413863070' target=_blank style='color:#2F92EE;'>#右心室功能障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38630, encryptionId=e9413863070, topicName=右心室功能障碍)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=abfe16361765, createdName=1194695146_61857352, createdTime=Sun Jul 12 03:22:21 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802168, encodeId=189e8021682e, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/ETmicU1bTbJ9wgxFrgiazzBvItYTRGkYZSS3aEWZpjNw6K2jslniacz0X6soibNf9wzYTmGltGbrKFBXnFQhrSLsXQ/132, createdBy=8d285168486, createdName=77665544332211, createdTime=Fri Jul 10 19:14:01 CST 2020, time=2020-07-10, status=1, ipAttribution=)]
    2020-07-12 slcumt
  8. 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    2020-07-10 77665544332211

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