Wang Zongyu, Li Hongliang, Yao Gaiqi, Zhu Xi
Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China. Corresponding author: Zhu Xi, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015 Mar;27(3):180-4. doi: 10.3760/cma.j.issn.2095-4352.2015.03.005.
To investigate the impacts of sepsis-induced cardiac dysfunction on hemodynamics, organ function and prognosis in the patients with septic shock.
A prospective cohort study was conducted in 44 patients suffering from septic shock with the duration < 24 hours admitted to the Department of Critical Care Medicine of Peking University Third Hospital during June 2013 to June 2014. The patients were divided into two groups according to the left ventricular ejection fraction (LVEF) as recorded in echocardiogram at time of admission to the intensive care unit (ICU) as sepsis-induced myocardial dysfunction group (LVEF < 0.50, n = 11) and normal cardiac function group (LVEF ≥ 0.50, n = 33). The cardiac function evaluation and hemodynamics monitoring were performed with echocardiogram and pulse-induced contour cardiac output (PiCCO) on 1, 3, 7 days after the ICU admission. The plasma levels of the biomarkers of myocardial damage, troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured, and the parameters representing organ function and the 28-day prognosis were collected as well.
On the ICU admission, central venous pressure (CVP) and left ventricular end-diastolic diameter (LVEDD) were obviously lower in normal cardiac function group than those of myocardial dysfunction group [CVP (mmHg, 1 mmHg = 0.133 kPa): 10 ± 4 vs. 14 ± 6, P < 0.05; LVEDD (mm): 45.0 ± 5.3 vs. 51.8 ± 7.1, P < 0.01], and there was no significant difference in other hemodynamic parameters between two groups. On the 3rd day, all the cardiac function and hemodynamic parameters showed no significant differences between the two groups. On the 7th day, the cardiac index (CI) and pulmonary vascular permeability index (PVPI) of normal cardiac function group were significantly higher than those of myocardial dysfunction group [CI (mL×s⁻¹×m⁻²): 63.3 ± 13.3 vs. 48.3 ± 10.0, P <0.05; PVPI: 1.5 (1.4, 1.9) vs. 1.1 (0.7, 1.1), P < 0.01], and no significant difference was found in the other parameters. The plasma levels of TnT and NT-proBNP were found to have no difference at three time points between two groups. There was no difference in the number or the extent of organ dysfunction, including lung, kidney, liver and coagulation system, between the groups at the time of ICU admission. There was no obvious difference in the 28-day survival rate between the myocardial dysfunction group and normal cardiac function group [81.8% (9/11) vs. 72.7% (24/33), χ² = 0.398, P = 0.528].
Sepsis-induced myocardial dysfunction is a reversible organ dysfunction. It can directly induce decreased left ventricular systolic function and enlargement of ventricle in patients with septic shock without reducing cardiac output or impairing the functions of other organs, or elevating the mortality rate.
探讨脓毒症诱导的心脏功能障碍对感染性休克患者血流动力学、器官功能及预后的影响。
对2013年6月至2014年6月北京大学第三医院重症医学科收治的44例病程<24小时的感染性休克患者进行前瞻性队列研究。根据入住重症监护病房（ICU）时超声心动图记录的左心室射血分数（LVEF）将患者分为两组，即脓毒症诱导的心肌功能障碍组（LVEF<0.50，n = 11）和心功能正常组（LVEF≥0.50，n = 33）。入住ICU后1、3、7天采用超声心动图和脉搏指示连续心输出量（PiCCO）进行心功能评估和血流动力学监测。检测心肌损伤生物标志物肌钙蛋白T（TnT）和N末端脑钠肽前体（NT-proBNP）的血浆水平，并收集代表器官功能和28天预后的参数。
入住ICU时，心功能正常组中心静脉压（CVP）和左心室舒张末期内径（LVEDD）明显低于心肌功能障碍组[CVP（mmHg，1 mmHg = 0.133 kPa）：10±4比14±6，P<0.05；LVEDD（mm）：45.0±5.3比51.8±7.1，P<0.01]，两组间其他血流动力学参数无显著差异。第3天时，两组的心功能和血流动力学参数均无显著差异。第7天时，心功能正常组的心指数（CI）和肺血管通透性指数（PVPI）明显高于心肌功能障碍组[CI（mL×s⁻¹×m⁻²）：63.3±13.3比48.3±10.0，P<0.05；PVPI：1.5（1.4，1.9）比1.1（0.7，1.1），P<0.01]，其他参数无显著差异。两组在三个时间点的TnT和NT-proBNP血浆水平无差异。入住ICU时，两组间包括肺、肾、肝和凝血系统在内的器官功能障碍的数量或程度无差异。心肌功能障碍组和心功能正常组的28天生存率无明显差异[81.8%（9/11）比72.7%（24/33），χ² = 0.398，P = 0.528]。
脓毒症诱导的心肌功能障碍是一种可逆的器官功能障碍。它可直接导致感染性休克患者左心室收缩功能下降和心室扩大，而不降低心输出量或损害其他器官功能，也不提高死亡率。
