本文關(guān)鍵詞：膿毒癥患者心室晚電位的變化特點(diǎn)及臨床價(jià)值　出處：《天津醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 膿毒癥 嚴(yán)重膿毒癥 膿毒性休克 心室晚電位

【摘要】：目的:觀察膿毒癥患者VLP的變化特點(diǎn),探討其與膿毒癥患者病情嚴(yán)重程度及預(yù)后的關(guān)系。方法:選取2014年7月至2015年4月期間在天津醫(yī)科大學(xué)總醫(yī)院急診醫(yī)學(xué)科收治的膿毒癥患者115例。根據(jù)病情嚴(yán)重程度分為膿毒癥組50例(年齡18~79歲)、嚴(yán)重膿毒癥組35例(年齡22~80歲)和膿毒性休克組30例(年齡23~79歲);根據(jù)患者28天死亡率分為存活組與死亡組。膿毒癥和嚴(yán)重膿毒癥及膿毒癥休克患者均符合2001年美國(guó)危重醫(yī)學(xué)會(huì)/歐洲危重癥醫(yī)學(xué)學(xué)會(huì)/美國(guó)胸科醫(yī)師協(xié)會(huì)/美國(guó)胸科學(xué)會(huì)/美國(guó)外科感染學(xué)會(huì)聯(lián)席會(huì)議提出的診斷標(biāo)準(zhǔn)。記錄所有患者的一般臨床資料、生命體征,監(jiān)測(cè)T、HR、MAP、CRP、PCT、24小時(shí)乳酸清除率、LAC、Pa O2、p H、WBC、c Tn T、H-FABP、BNP、ECG、VLP及UCG等檢查,根據(jù)患者入院24小時(shí)內(nèi)最差臨床指標(biāo)計(jì)算APACHE II。分別于診斷膿毒癥后第1天、第3天及第7天清晨采集靜脈血測(cè)定c Tn T、H-FABP、BNP水平,分析不同嚴(yán)重程度膿毒癥患者VLP的動(dòng)態(tài)變化,并將患者VLP陽(yáng)性改變與24小時(shí)乳酸清除率、LAC、PCT和APACHE II評(píng)分進(jìn)行相關(guān)性分析。采用SPSS 17.0統(tǒng)計(jì)軟件包進(jìn)行數(shù)據(jù)處理,正態(tài)分布的定量資料用均數(shù)±標(biāo)準(zhǔn)差表示,非正態(tài)分布的資料采用中位數(shù)、最小值和最大值表示。正態(tài)分布、方差齊的計(jì)量資料三組樣本間比較采用單因素方差分析one-way ANOVA,三組間兩兩比較采用q檢驗(yàn);定性資料采用卡方檢驗(yàn)。在單因素分析觀察對(duì)象的各項(xiàng)臨床指標(biāo)的基礎(chǔ)上,對(duì)有意義的變量再進(jìn)行多因素非條件Logistic回歸分析。再以對(duì)判斷有意義的指標(biāo)繪制受試者工作特征曲線(receiver operator characteristic curve,ROC),分別計(jì)算各個(gè)指標(biāo)的ROC曲線下面積,比較其判斷預(yù)后的敏感性和特異性。以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:(1)三組患者年齡、性別、T、HR、MAP、PaO2、pH無(wú)顯著性差異(P0.05);CRP、PCT、24小時(shí)乳酸清除率、LAC、WBC、c Tn T、H-FABP、BNP、APACHE II評(píng)分比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);(2)膿毒癥組、嚴(yán)重膿毒癥組和膿毒性休克組VLP陽(yáng)性檢出率分別為36.00%、51.42%和66.67%;膿毒性休克組較其他兩組VLP陽(yáng)性檢出率、TQRS、LAS40顯著升高,RMS40減低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);(3)三組VLP陽(yáng)性檢出組患者c TNT、H-FABP、BNP均高于陰性檢出組(P0.05);膿毒性休克組VLP陰性與陽(yáng)性檢出組c Tn T、H-FABP、BNP濃度較其他兩組明顯升高(P0.05);(4)膿毒性休克組VLP陰性、陽(yáng)性檢出組患者LVEDV、LVESV明顯高于膿毒癥組、嚴(yán)重膿毒癥組,SV和LVEF明顯減低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);(5)膿毒癥死亡組患者陽(yáng)性檢出率、TQRS、LAS40較存活組高,陰性檢出率、RMS40較存活組低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);(6)Spearman相關(guān)分析顯示,APACHE II評(píng)分與VLP陽(yáng)性改變、24小時(shí)乳酸清除率、LAC、PCT均呈正相關(guān);(7)單因素分析顯示,CRP、PCT、24小時(shí)乳酸清除率、LAC、WBC、c Tn T、H-FABP、BNP、VLP陽(yáng)性改變、APACHE II與患者預(yù)后有關(guān)。多元Logistic回歸分析顯示,APACHE II評(píng)分、24小時(shí)乳酸清除率、LAC、PCT是判斷膿毒癥患者預(yù)后的獨(dú)立危險(xiǎn)因素(P0.05),而VLP陽(yáng)性改變不是判斷預(yù)后的獨(dú)立危險(xiǎn)因素(P0.05);(8)ROC曲線分析顯示,VLP陽(yáng)性改變聯(lián)合LAC的敏感性為0.818,特異性為0.786。結(jié)論:膿毒癥患者隨著疾病嚴(yán)重程度增加,VLP陽(yáng)性率、TQRS、LAS40越高,RMS40越低;膿毒癥患者VLP陽(yáng)性改變與預(yù)后有關(guān),但不能作為判斷患者預(yù)后的獨(dú)立危險(xiǎn)因素;VLP陽(yáng)性改變聯(lián)合LAC可以提高對(duì)判斷膿毒癥嚴(yán)重程度評(píng)估的敏感性。
[Abstract]:Objective: To observe the changes of VLP in patients with sepsis, and to study its relation with the severity of patients with sepsis and prognosis. Methods: during the period from July 2014 to April 2015 in 115 cases in General Hospital Affiliated to Tianjin Medical University emergency department patients with sepsis admitted. According to the severity of the disease is divided into sepsis group of 50 patients (aged 18~79 years), severe sepsis group 35 cases (aged 22~80 years) and septic shock group 30 patients (aged 23~79 years); according to the 28 day mortality rate divided into survival group and death group. The sepsis and severe sepsis and septic shock are in line with the United States in 2001 / critical care medicine in Europe Critical Medicine Association / American Association for thoracic surgeons / American Thoracic Society / the surgical infection diagnosis standard joint meeting. Learn to put record the general clinical data, all patients vital signs monitoring T, HR, MAP, CRP, PCT, 24 hour lactic acid clearance rate LAC, Pa, O2, P, H, WBC, C Tn T, H-FABP, BNP, ECG, VLP and UCG examination, according to the patients within 24 hours after admission the worst clinical index calculation of APACHE II. in the diagnosis of sepsis after first days, third days and 7 days in the morning C Tn T collected blood samples. H-FABP, BNP, dynamic change analysis of different severity of sepsis in patients with VLP, and the change of VLP positive patients and 24 hour lactic acid clearance rate, LAC, PCT and APACHE II score were analyzed. Data were processed by SPSS 17 statistical software, the quantitative data of normal distribution with standard deviation said that the non normal distribution of data using the median, minimum and maximum value. The normal distribution of measurement data of three samples of variance compared with single factor analysis of variance and one-way ANOVA, three between the 22 groups were compared with Q test; qualitative data by chi square test. In the observation and analysis of single factor Based on the clinical indicators as the significant variables, then the multi factor non conditional Logistic regression analysis. Then make sense to judge the index of the receiver operating characteristic curve (receiver operator characteristic curve, ROC), ROC curve area of each index were calculated, compared with the prognostic sensitivity and the specificity of P0.05 difference was statistically significant. Results: (1) three groups of age, gender, T, HR, MAP, PaO2, pH had no significant difference (P0.05); CRP, PCT, 24 hours lactate clearance rate, LAC, WBC, C Tn T, H-FABP, BNP, comparison APACHE II scores, the differences were statistically significant (P0.05); (2) sepsis group, severe sepsis group and septic shock group VLP positive rates were 36%, 51.42% and 66.67%; septic shock group than the other two groups. The positive rate of VLP, TQRS, LAS40 were significantly increased, RMS40 decreased. The difference has statistics 瀛︽剰涔，

本文編號(hào)：1411802