现代医药卫生
現代醫藥衛生
현대의약위생
MODERN MEDICINE HEALTH
2014年
13期
1933-1935
,共3页
休克,脓毒性%预后%心肌损伤
休剋,膿毒性%預後%心肌損傷
휴극,농독성%예후%심기손상
Shock,septic%Prognosis%Myocardial injury
目的：探讨感染性休克患者心肌损伤程度与预后的关系。方法将2011年1月至2014年1月收治的36例伴心肌损伤的感染性休克患者分为A、B组各18例。两组患者均有不同程度心肌损伤，A组患者肌钙蛋白I（cTnI）≥2.00μg/L（正常值：0.00～0.03μg/L）、脑钠肽（BNP）≥300 pg/mL（正常值：<100 pg/mL）及肌酸激酶同工酶（CK鄄MB）≥40 U/L （正常值：<25 U/L），B组患者cTnI 0.03～＜2.00μg/L、BNP 100～＜300 pg/mL及CK鄄MB 25～＜40 U/L，两组患者均给予液体复苏、血管活性药物、抗菌药物、氧疗（加压吸氧、有创或无创机械通气）、营养心肌，以及根据不同病情部分患者选用床边血液净化治疗（16例）等。观察两组患者治疗前后急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分、cTnI、BNP、CK鄄MB、血乳酸（Lac）、降钙素原（PCT）、白介素（IL）鄄6、平均动脉压（MAP）、病死率等变化。结果两组患者治疗前APACHEⅡ评分， PCT、IL鄄6水平比较，差异均无统计学意义（P>0.05）；治疗14 d后，B组患者APACHEⅡ评分，cTnI、BNP、CK鄄MB、PCT、Lac、IL鄄6水平，病死率[分别为（6.36±3.62）分、（0.36±0.25）μg/L、（152.65±12.84）pg/mL、（16.48±5.26）U/L、（1.25±0.50）ng/L、（1.32±1.06）mmol/L、（8.26±3.34）pg/mL、11.11%]较A 组[分别为（20.49±7.43）分、（2.48±1.34）μg/L、（324.13±64.31）pg/mL、（26.34±8.67）U/L、（3.16±2.24）ng/L、（3.65±2.16）mmol/L、（10.38±4.36）pg/mL、33.33%]显著下降，MAP[（75.36±9.86）mm Hg（1 mm Hg=0.133 kPa）]较A组[（68.38±8.75）mm Hg]明显上升，差异均有统计学意义（P<0.05）。结论感染性休克患者病死率与心肌损伤程度呈正相关，一旦出现严重心肌损伤导致心力衰竭，即使应用床边血液净化治疗等先进措施仍无法有效提高患者生存率，预后差于心肌损伤较轻的患者。
目的：探討感染性休剋患者心肌損傷程度與預後的關繫。方法將2011年1月至2014年1月收治的36例伴心肌損傷的感染性休剋患者分為A、B組各18例。兩組患者均有不同程度心肌損傷，A組患者肌鈣蛋白I（cTnI）≥2.00μg/L（正常值：0.00～0.03μg/L）、腦鈉肽（BNP）≥300 pg/mL（正常值：<100 pg/mL）及肌痠激酶同工酶（CK鄄MB）≥40 U/L （正常值：<25 U/L），B組患者cTnI 0.03～＜2.00μg/L、BNP 100～＜300 pg/mL及CK鄄MB 25～＜40 U/L，兩組患者均給予液體複囌、血管活性藥物、抗菌藥物、氧療（加壓吸氧、有創或無創機械通氣）、營養心肌，以及根據不同病情部分患者選用床邊血液淨化治療（16例）等。觀察兩組患者治療前後急性生理和慢性健康狀況Ⅱ（APACHEⅡ）評分、cTnI、BNP、CK鄄MB、血乳痠（Lac）、降鈣素原（PCT）、白介素（IL）鄄6、平均動脈壓（MAP）、病死率等變化。結果兩組患者治療前APACHEⅡ評分， PCT、IL鄄6水平比較，差異均無統計學意義（P>0.05）；治療14 d後，B組患者APACHEⅡ評分，cTnI、BNP、CK鄄MB、PCT、Lac、IL鄄6水平，病死率[分彆為（6.36±3.62）分、（0.36±0.25）μg/L、（152.65±12.84）pg/mL、（16.48±5.26）U/L、（1.25±0.50）ng/L、（1.32±1.06）mmol/L、（8.26±3.34）pg/mL、11.11%]較A 組[分彆為（20.49±7.43）分、（2.48±1.34）μg/L、（324.13±64.31）pg/mL、（26.34±8.67）U/L、（3.16±2.24）ng/L、（3.65±2.16）mmol/L、（10.38±4.36）pg/mL、33.33%]顯著下降，MAP[（75.36±9.86）mm Hg（1 mm Hg=0.133 kPa）]較A組[（68.38±8.75）mm Hg]明顯上升，差異均有統計學意義（P<0.05）。結論感染性休剋患者病死率與心肌損傷程度呈正相關，一旦齣現嚴重心肌損傷導緻心力衰竭，即使應用床邊血液淨化治療等先進措施仍無法有效提高患者生存率，預後差于心肌損傷較輕的患者。
목적：탐토감염성휴극환자심기손상정도여예후적관계。방법장2011년1월지2014년1월수치적36례반심기손상적감염성휴극환자분위A、B조각18례。량조환자균유불동정도심기손상，A조환자기개단백I（cTnI）≥2.00μg/L（정상치：0.00～0.03μg/L）、뇌납태（BNP）≥300 pg/mL（정상치：<100 pg/mL）급기산격매동공매（CK견MB）≥40 U/L （정상치：<25 U/L），B조환자cTnI 0.03～＜2.00μg/L、BNP 100～＜300 pg/mL급CK견MB 25～＜40 U/L，량조환자균급여액체복소、혈관활성약물、항균약물、양료（가압흡양、유창혹무창궤계통기）、영양심기，이급근거불동병정부분환자선용상변혈액정화치료（16례）등。관찰량조환자치료전후급성생리화만성건강상황Ⅱ（APACHEⅡ）평분、cTnI、BNP、CK견MB、혈유산（Lac）、강개소원（PCT）、백개소（IL）견6、평균동맥압（MAP）、병사솔등변화。결과량조환자치료전APACHEⅡ평분， PCT、IL견6수평비교，차이균무통계학의의（P>0.05）；치료14 d후，B조환자APACHEⅡ평분，cTnI、BNP、CK견MB、PCT、Lac、IL견6수평，병사솔[분별위（6.36±3.62）분、（0.36±0.25）μg/L、（152.65±12.84）pg/mL、（16.48±5.26）U/L、（1.25±0.50）ng/L、（1.32±1.06）mmol/L、（8.26±3.34）pg/mL、11.11%]교A 조[분별위（20.49±7.43）분、（2.48±1.34）μg/L、（324.13±64.31）pg/mL、（26.34±8.67）U/L、（3.16±2.24）ng/L、（3.65±2.16）mmol/L、（10.38±4.36）pg/mL、33.33%]현저하강，MAP[（75.36±9.86）mm Hg（1 mm Hg=0.133 kPa）]교A조[（68.38±8.75）mm Hg]명현상승，차이균유통계학의의（P<0.05）。결론감염성휴극환자병사솔여심기손상정도정정상관，일단출현엄중심기손상도치심력쇠갈，즉사응용상변혈액정화치료등선진조시잉무법유효제고환자생존솔，예후차우심기손상교경적환자。
Objective To investigate the relationship between degree of myocardial injury of patients with septic shock and prognosis. Methods Thirty-six septic shock patients with myocardial injury ,who were received from January 2011 to Jan-uary 2014,were divided into group A and group B,18 cases in each group. The patients in both groups had varying degrees of my-ocardial injury. In the group A,patients′cardiac troponin I (cTnI)≥2.0μg/L(normal value:0-0.03μg/L),brain natriuretic peptide (BNP)≥300 pg/mL(normal value<100 pg/mL) and creatine kinase-MB(CK-MB)≥40 U/L(normal value<25 U/L);while in the group B,cTnI:0.03-<2.00μg/L,BNP:100-<300 pg/mL and CK-MB:25-<40 U/L. Both groups were treated with fluid resuscita-tion,vasoactive drugs,antibacterial agents,oxygen therapy (pressurized oxygen uptake,invasive or noninvasive mechanical venti-lation),blood purification treatment (16 cases) according to the conditions of disease and so on. Acute physiology and chronic health evaluationⅡ(APACHEⅡ) score and changes of cTnI,BNP,CK-MB,blood lactate acid(Lac),procalcitonin(PCT),inter-leukin(IL)-6,mean arterial pressure(MAP) and fatality rate in the two groups before and after treatment were observed. Results The comparison between the two groups on APACHEⅡscore,PCT level and IL-6 level before treatment had no statistically significant difference(P>0.05).14 days after treatment,the APACHEⅡscore,levels of cTnI,BNP,CK-MB,PCT,Lac,IL-6 and fa-tality rate in the group B were 6.36±3.62,(0.36±0.25)μg/L,(152.65±12.84)pg/mL,(16.48±5.26)U/L,(1.25±0.05)ng/L,(1.32± 1.06)mmol/L,(8.26±3.34)pg/mL and 11.11%respectively,which decreased prominently than those in the group A[20.49±7.43, (2.48±1.34)μg/L,(324.13±64.31)pg/mL,(26.34±8.67)U/L,(3.16±2.24)ng/L,(3.65±2.16)mmol/L,(10.38±4.36)pg/mL and 33.33%respectively],and the MAP in the group B decreased more obviously than that in the group A[(75.36±9.86)mm Hg(1 mm Hg=0.133 kPa) vs (68.38±8.75)mm Hg],the difference between the two groups had statistical significance (P<0.05). Conclusion Fatality rate of septic shock patients is positively correlated with myocardial injury. For the cardiac failure induced by serious my-ocardial injury,even if the application of bedside blood purification therapy and other advanced measures are still unable to effec-tively improve the survival rate,and prognosis is poorer than the patients with lighter myocardial injury.
