【摘要】 目的研究危重症患者合并应激性心肌病的死亡相关危险因素。方法回顾性分析2007年1月1日-2017年6月30日北京某医院危重医学科收治的38例合并应激性心肌病的患者临床资料。按照患者在ICU的治疗结果将患者分为经治疗后存活组和死亡组。分析8项危险因素对患者预后的影响。这8项因素包括:性别、年龄、既往是否合并心脏病史、是否合并感染疾病、确诊应激性心肌病后首次超声心动图检查左室射血分数、心肌酶、肌钙蛋白、APACHEⅡ评分共8项指标进行单因素分析,单因素分析有统计学意义(P<0.05)的指标再进行logistic逐步回归分析。独立影响因素通过绘制ROC曲线,分析独立危险因素对患者预后的评估价值。结果本研究纳入的38例患者,其中9例患者在ICU治疗期间死亡,另外29例患者存活。两组患者性别、心肌酶值、肌钙蛋白值、是否合并感染疾病五项指标比较差异均无统计学意义(p值>0.05)。死亡组患者与存活组相比:年龄明显偏大(70.1±16.6岁,59.2±12.5岁)(P值0.000);APACHEⅡ评分明显偏高(19.1±3.2,15.2±2.2)(P值0.000);确诊应激性心肌病后超声心动图检查左室射血分数值明显降低(23.2%±3.7%,31.2%±3.5%)(P值0.000)。logistic逐步回归分析显示确诊应激性心肌病后超声心动图检查左室射血分数值明显降低为危重症患者合并应激性心肌病的死亡的独立影响因素(P=0.032)。ROC曲线分析结果显示,确诊应激性心肌病后超声心动图检查左室射血分数值降低26%以下对合并应激性心肌病的危重症患者死亡发生具有预测价值,ROC曲线下面积为0.946,当截断值分别为0.26时,敏感度为分别88.89%,特异度为96.55%。结论合并应激性心肌病的危重症患者的死亡相关危险因素包括患者高龄、左室射血分数值降低、APACHEⅡ评分高,其中左室射血分数值降低为死亡独立危险因素。左室射血分数值降低至26%以下可预测患者死亡几率增高。更多还原

【Abstract】 Objective To study the risk factors associated with death in critically ill patients combined with stress-induced cardiomyopathy. Methods A retrospective study was conducted in 38 patients combined with stress-induced cardiomyopathy in ICU of a hospital in Peking from January 1, 2016 to June 30, 2017. The patients were divided into two groups according to the treatment outcone in ICU: death group and survival group. The eight indexes include gender, age, heart disease history, concurrent infection, initial LVEF(left ventricular ejection fraction), myocardial enzyme, cardiac troponin and APACHEⅡscore(acute physiology and chronic health status score) were compared between two groups. The variables with significance(P<0.05)in the univariate analysis then entered stepwise logistic regression analysis. The independent risk factor was drawed the ROC curve analysis of independent risk factors for the assessment of prognosis. Results There were no significant differences in gender,heart disease history, concurrent infection, myocardial enzyme and cardiac troponin between two groups. The average age and APACHEⅡscore were significantly higher in death group than in survival group(70.1±16.6 yr vs59.2±12.5 yr)(P value 0.000)( 19.1±3.2 vs 15.2±2.2)(P value 0.000). The LVEF was significantly lower in death group than that in survival group(23.2 %±3.7% vs 31.2%±3.5%)(P value 0.000). The stepwise logistic regression analysis indicated that the decrease of LEVF was the independent risk factor. It was shown by ROC curve analysis that the area under ROC curve(AUC) of LVEF for evaluating prognosis was 0.946. when the cut-off of LVEF was 0.26, the sensitivity were 88.89%, and the specificity were 96.55%. Conclusions The risk factors related to death in critically ill patients with stress-induced cardiomyopathy include old age, high APACHE II score, and decreased left ventricular ejection fraction,and the independent risk factors for death is decreased left ventricular ejection fraction. The decrease in left ventricular ejection fraction below 26% predicts an increased risk of death in these patients.更多还原