本文選題：膿毒癥 + 心功能障礙　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:膿毒癥在重癥加強監(jiān)護病房發(fā)病率很高,膿毒癥3.0將膿毒癥定義為針對感染的失調(diào)的宿主反應(yīng)引起的危及生命的器官功能障礙,更加強調(diào)器官功能障礙的重要性,其引起的器官功能障礙包括呼吸系統(tǒng)、中樞神經(jīng)系統(tǒng)、血液系統(tǒng)及心血管系統(tǒng)等,膿毒癥的心功能障礙是心血管系統(tǒng)對疾病過程、宿主反應(yīng)和復(fù)蘇的動態(tài)適應(yīng)所表現(xiàn)的最復(fù)雜的器官衰竭之一。隨著床旁超聲心動圖技術(shù)在重癥監(jiān)護病房中的應(yīng)用,許多研究已經(jīng)描述了在膿毒癥中存在不同類型的心功能障礙。人們已經(jīng)從只關(guān)注左心室(LV)收縮功能障礙向識別其他類型的心功能障礙轉(zhuǎn)變,作為心功能障礙的一部分類型可能有不同的治療方案及對患者預(yù)后產(chǎn)生影響。膿毒癥性心功能障礙包括左室收縮功能障礙,左室舒張功能障礙和右心室功能障礙。各類型心功能障礙可以單獨或組合存在,并且在恢復(fù)期是可逆性的。盡管不同類型的心功能障礙已在某種程度上被評估,但其定義和臨床表現(xiàn)缺乏共識。心功能障礙對膿毒癥患者的預(yù)后影響尚不明確,本課題應(yīng)用經(jīng)胸床旁超聲心動圖對膿毒癥患者心功能障礙進行觀察并評價其對28天和60天死亡率的影響。方法:選擇2016年1月1日至2016年12月31日河北省滄州市中心醫(yī)院急診重癥監(jiān)護室(EICU)收治的53例膿毒癥患者進行了前瞻性觀察研究。入住重癥監(jiān)護室24小時以內(nèi)首次行床旁超聲心動圖檢測,記錄左心室收縮功能指標:左室射血分數(shù)、左心室舒張功能指標:采用脈沖多普勒測定的二尖瓣舒張早期峰流速與組織多普勒測定的二尖瓣環(huán)舒張早期速度比值(E/E’),右心收縮功能指標:三尖瓣收縮期位移(TAPSE),同時記錄一般臨床資料、生理參數(shù)、包括血流動力學(xué)參數(shù)、和血管活性用量,并進行APACHE II及SOFA評分,根據(jù)超聲結(jié)果將患者分為心功能正常組、心功能障礙組、心功能障礙進一步分為左心室(LV)收縮、舒張功能障礙和右心室(RV)功能障礙。計算各類心功能障礙的發(fā)生率,并比較無心功能障礙和不同類型的心功能障礙在人口學(xué)、血流動力學(xué)、生理變量和28天、60天死亡率的差異。結(jié)果:共納入53例患者。平均年齡62±17歲,男性27例,女性26例。記錄到病原學(xué)結(jié)果30例(57%),其中血培養(yǎng)陽性10例結(jié)果占19%,其他標本包括痰、尿、引流液、分泌物等的微生物陽性培養(yǎng)源20例(38%),18例(33%)進行培養(yǎng)未得到明確陽性病原學(xué)結(jié)果,5例(10%)由于各種原因未進行培養(yǎng)。所有膿毒癥患者中肺部感染10例(17%),膽囊炎3例(6%),肝膿腫3例(6%),菌血癥4例(8%),軟組織感染7例(13%)、消化道感染7例(13%)、泌尿系感染3例(6%)、流行性出血熱2例(4%)、神經(jīng)系統(tǒng)感染4例(8%)、混合感染8例(15%)、未明確感染源2例(4%)。根據(jù)心臟超聲結(jié)果將病人分成四組,分別為心功能正常組、左心室收縮功能障礙組、左心室舒張功能障礙組、右心室功能障礙組,其中心功能正常的患者有19例患者(36%),有心功能障礙的為34例,占總?cè)藬?shù)的64%。左室收縮功能不全的有14例(26%),左心室舒張功能障礙的有20例(38%),和右心室功能不全的16例(30%)。心功能障礙類型之間存在相互重疊,3例(6%)存在左心室收縮和舒張功能障礙,右心室功能正常,5例(9%)有雙心室收縮功能障礙,舒張功能正常,4例(8%)存在左心室舒張及右心室功能障礙,2例(4%)顯示存在舒張功能障礙,合并左心室和右心室收縮功能障礙,總共有19例(36%)28天內(nèi)死亡,有30例(57%)在60內(nèi)死亡,正常心功能組與心功能障礙組28天和60天的病死率分別為42%、32%和53%、57%(P=0.31 vs P=0.83)無統(tǒng)計學(xué)意義。結(jié)論:1心功能障礙在膿毒癥中是常見的,包括左室收縮,左室舒張,和右心室功能障礙,以左室射血分數(shù)(LVEF)下降作為膿毒癥性心功能障礙評價唯一標準具有局限性。2床旁超聲心動圖觀察膿毒癥性心功能障礙患者和無心功能障礙患者在28天或60天的病死率無顯著差異。3在重癥加強監(jiān)護病房,床旁超聲心動圖的應(yīng)用有助于為膿毒癥性心功能障礙的診斷和分型及干預(yù)措施提供重要依據(jù)。
[Abstract]:Objective: the incidence of sepsis in intensive care unit is very high. Sepsis 3 defines sepsis as a life threatening organ dysfunction caused by a host response to the imbalance of infection and emphasizes the importance of organ dysfunction, which includes the respiratory system, the central nervous system, the blood system and the system of organ dysfunction. Cardiac dysfunction, such as the cardiovascular system, is one of the most complex organ failure of the cardiovascular system for the disease process, the dynamic adaptation of the host response and the resuscitation. With the application of the bedside echocardiography in the intensive care unit, many studies have described the existence of different types of cardiac function in sepsis. Obstacles. People have changed from only concerned with the left ventricular (LV) systolic dysfunction to identifying other types of cardiac dysfunction. As a part of the heart dysfunction, there may be different treatments and effects on the prognosis. Septic cardiac dysfunction includes left ventricular systolic dysfunction, left ventricular diastolic dysfunction, and right heart. Ventricular dysfunction. Various types of cardiac dysfunction may exist alone or in combination, and are reversible in the recovery period. Although different types of cardiac dysfunction have been evaluated to some extent, their definition and clinical manifestations are lacking consensus. The effect of cardiac dysfunction on the prognosis of septic patients is not clear. Echocardiography was used to observe cardiac dysfunction in patients with sepsis and to evaluate its effect on mortality at 28 and 60 days. Methods: a prospective study of 53 cases of sepsis in the emergency intensive care unit (EICU) of Cangzhou Central Hospital in Hebei province from January 1, 2016 to December 31, 2016 was studied. 24 small patients were admitted to the intensive care unit. The left ventricular systolic function index: left ventricular ejection fraction and left ventricular diastolic function index: the early peak velocity of mitral valvular diastolic velocity measured by pulsed Doppler and the early diastolic velocity ratio of mitral annulus measured by tissue Doppler (E/E '), and the index of right cardiac contractile function: three apical valve contraction. Phase shift (TAPSE), also recorded general clinical data, physiological parameters, including hemodynamic parameters, and vasoactive dosage, and APACHE II and SOFA scores. According to ultrasound results, the patients were divided into normal cardiac function group, heart dysfunction group, and cardiac dysfunction was divided into left ventricular (LV) contraction, diastolic dysfunction and right ventricle (RV). The incidence of various types of cardiac dysfunction was calculated, and the differences in demography, hemodynamics, physiological variables and 28 day, 60 day mortality were compared with non cardiac dysfunction and different types of cardiac dysfunction. Results: a total of 53 patients were included. The average age was 62 + 17 years, 27 men and 26 women. The results were recorded in 30 cases (57%). The results of 10 cases of positive medium blood culture were 19%, other specimens included sputum, urine, drainage and secretion, 20 cases (38%), 18 cases (33%) had no definite positive pathogenic results, 5 cases (10%) were not cultured for various reasons. All the patients with sepsis were pulmonary infection in 10 cases (17%), cholecystitis 3 (6%), hepatic abscess 3 Cases (6%), 4 cases of bacteremia (8%), 7 cases of soft tissue infection (13%), 7 cases of digestive tract infection (13%), 3 cases of urinary tract infection (6%), 2 cases of epidemic hemorrhagic fever (4%), 4 cases of nervous system infection (8%), mixed infection in 8 cases, and no definite source of infection. Disorder group, left ventricular diastolic dysfunction group, right ventricular dysfunction group, 19 patients with normal central function (36%), 34 cases with cardiac dysfunction, 14 cases (26%) of 64%. left ventricular systolic dysfunction, 20 cases of left ventricular diastolic dysfunction (38%), and 16 cases of right ventricular dysfunction (30%). Cardiac function 3 cases (6%) had left ventricular systolic and diastolic dysfunction, right ventricular function, 5 cases (9%) had diastolic dysfunction, normal diastolic function, 4 cases (8%) with left ventricular diastolic and right ventricular dysfunction, 2 cases (4%) showed diastolic dysfunction, and left ventricular and right ventricular systolic work in 2 cases (4%). A total of 19 cases (36%) died within 28 days, 30 (57%) died within 60, and 28 days and 60 days in the normal cardiac function group and cardiac dysfunction group were 42%, 32% and 53%, and 57% (P=0.31 vs P=0.83) were not statistically significant. Conclusion: 1 cardiac dysfunction is common in sepsis, including left ventricular systolic, left ventricular diastolic, and right ventricular work. Impairment of left ventricular ejection fraction (LVEF) as the sole criterion for evaluation of septic cardiac dysfunction with limited.2 bedside echocardiography observation of the mortality of patients with septic cardiac dysfunction and careless dysfunction at 28 days or 60 days.3 in intensive care intensive care unit, bedside echocardiography should It can help to provide important evidence for diagnosis, typing and intervention of septic cardiac dysfunction.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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相關(guān)期刊論文 前1條

1 呼邦傳;王宇佳;葛偉東;李鋒之;孫仁華;;血漿B型腦利鈉肽聯(lián)合左室舒張功能障礙對膿毒癥休克患者預(yù)后的評估[J];中華醫(yī)學(xué)雜志;2016年29期

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本文編號：1946060