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脓毒症和脓毒性休克患者队列中脓毒症诱导的心肌病的发病率和演变情况。

Incidence and evolution of sepsis-induced cardiomyopathy in a cohort of patients with sepsis and septic shock.

作者信息

Narváez I, Canabal A, Martín C, Sánchez M, Moron A, Alcalá J, Giacoman S, Magro M

机构信息

Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España.

Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España.

出版信息

Med Intensiva (Engl Ed). 2018 Jun-Jul;42(5):283-291. doi: 10.1016/j.medin.2017.08.008. Epub 2017 Nov 1.

Abstract

OBJETIVE

The aim of this study was to establish the incidence of septic cardiomyopathy (SM) in patients with sepsis and septic shock, to describe its characteristics and testing its evolution.

DESIGN

Prospective cohort study.

PARTICIPANTS

We included 57 consecutive patients admitted to Intensive Care Unit, who met criteria of sepsis and septic shock.

PRINCIPAL VARIABLES OF INTEREST

Clinical and biochemical variables were analyzed. An echocardiogram was performed in the first 24hours of admission, determining myocardial function parameters, and if the patients had left ventricular ejection fraction (LVEF)<50%) a second echocardiogram was performed.

AMBIT

Intensive medical and surgical Care Service for Adults in University Hospital.

RESULTS

The mean age of the patients was 62,1±16,3 years. 58% were males. 22.8% had left ventricular dysfunction. The mean LVEF in patients with MS was lower than those without SM (34.1±10.6 vs 60.7±6.94%, P<.001), with complete recovery, in survivors, after the acute event (LVEF at discharge 56.1±6.3%, P=.04). Patients with SM had higher levels of procalcitonin (47.1±35.4 vs 18.9±24.5; P=.02) and higher score on the Sequential Organ Failure Assessment (SOFA score) (9.91±3.82 vs 7.47±3.41; P=.037). Mortality was not significantly different between both groups [4 (30.8%) vs 4 (9.1%); P=.07].

CONCLUSIONS

SM is not uncommon and is related to a higher scores on the severity scales. In the survivors, LVEF normalized after the recovery of the acute event.

摘要

目的

本研究旨在确定脓毒症和脓毒性休克患者中脓毒症性心肌病(SM)的发病率,描述其特征并观察其病情演变。

设计

前瞻性队列研究。

参与者

我们纳入了57例连续入住重症监护病房且符合脓毒症和脓毒性休克标准的患者。

主要研究变量

分析临床和生化变量。入院后24小时内进行超声心动图检查,测定心肌功能参数,若患者左心室射血分数(LVEF)<50%,则进行第二次超声心动图检查。

研究范围

大学医院的成人心内科和心外科重症监护服务。

结果

患者的平均年龄为62.1±16.3岁。58%为男性。22.8%存在左心室功能障碍。SM患者的平均LVEF低于无SM患者(34.1±10.6对60.7±6.94%,P<0.001),在幸存者中,急性事件后LVEF完全恢复(出院时LVEF为56.1±6.3%,P = 0.04)。SM患者的降钙素原水平较高(47.1±35.4对18.9±24.5;P = 0.02),序贯器官衰竭评估(SOFA评分)更高(9.91±3.82对7.47±3.41;P = 0.037)。两组死亡率无显著差异[4例(30.8%)对4例(9.1%);P = 0.07]。

结论

SM并不罕见,且与严重程度评分较高有关。在幸存者中,急性事件恢复后LVEF恢复正常。

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