脓毒症患者心室晚电位的变化特点及临床价值

发布时间：2018-01-12 00:05

  本文关键词：脓毒症患者心室晚电位的变化特点及临床价值　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 脓毒症 严重脓毒症 脓毒性休克 心室晚电位

【摘要】：目的:观察脓毒症患者VLP的变化特点,探讨其与脓毒症患者病情严重程度及预后的关系。方法:选取2014年7月至2015年4月期间在天津医科大学总医院急诊医学科收治的脓毒症患者115例。根据病情严重程度分为脓毒症组50例(年龄18~79岁)、严重脓毒症组35例(年龄22~80岁)和脓毒性休克组30例(年龄23~79岁);根据患者28天死亡率分为存活组与死亡组。脓毒症和严重脓毒症及脓毒症休克患者均符合2001年美国危重医学会/欧洲危重症医学学会/美国胸科医师协会/美国胸科学会/美国外科感染学会联席会议提出的诊断标准。记录所有患者的一般临床资料、生命体征,监测T、HR、MAP、CRP、PCT、24小时乳酸清除率、LAC、Pa O2、p H、WBC、c Tn T、H-FABP、BNP、ECG、VLP及UCG等检查,根据患者入院24小时内最差临床指标计算APACHE II。分别于诊断脓毒症后第1天、第3天及第7天清晨采集静脉血测定c Tn T、H-FABP、BNP水平,分析不同严重程度脓毒症患者VLP的动态变化,并将患者VLP阳性改变与24小时乳酸清除率、LAC、PCT和APACHE II评分进行相关性分析。采用SPSS 17.0统计软件包进行数据处理,正态分布的定量资料用均数±标准差表示,非正态分布的资料采用中位数、最小值和最大值表示。正态分布、方差齐的计量资料三组样本间比较采用单因素方差分析one-way ANOVA,三组间两两比较采用q检验;定性资料采用卡方检验。在单因素分析观察对象的各项临床指标的基础上,对有意义的变量再进行多因素非条件Logistic回归分析。再以对判断有意义的指标绘制受试者工作特征曲线(receiver operator characteristic curve,ROC),分别计算各个指标的ROC曲线下面积,比较其判断预后的敏感性和特异性。以P0.05为差异有统计学意义。结果:(1)三组患者年龄、性别、T、HR、MAP、PaO2、pH无显著性差异(P0.05);CRP、PCT、24小时乳酸清除率、LAC、WBC、c Tn T、H-FABP、BNP、APACHE II评分比较,差异均有统计学意义(P0.05);(2)脓毒症组、严重脓毒症组和脓毒性休克组VLP阳性检出率分别为36.00%、51.42%和66.67%;脓毒性休克组较其他两组VLP阳性检出率、TQRS、LAS40显著升高,RMS40减低,差异具有统计学意义(P0.05);(3)三组VLP阳性检出组患者c TNT、H-FABP、BNP均高于阴性检出组(P0.05);脓毒性休克组VLP阴性与阳性检出组c Tn T、H-FABP、BNP浓度较其他两组明显升高(P0.05);(4)脓毒性休克组VLP阴性、阳性检出组患者LVEDV、LVESV明显高于脓毒症组、严重脓毒症组,SV和LVEF明显减低,差异具有统计学意义(P0.05);(5)脓毒症死亡组患者阳性检出率、TQRS、LAS40较存活组高,阴性检出率、RMS40较存活组低,差异具有统计学意义(P0.05);(6)Spearman相关分析显示,APACHE II评分与VLP阳性改变、24小时乳酸清除率、LAC、PCT均呈正相关;(7)单因素分析显示,CRP、PCT、24小时乳酸清除率、LAC、WBC、c Tn T、H-FABP、BNP、VLP阳性改变、APACHE II与患者预后有关。多元Logistic回归分析显示,APACHE II评分、24小时乳酸清除率、LAC、PCT是判断脓毒症患者预后的独立危险因素(P0.05),而VLP阳性改变不是判断预后的独立危险因素(P0.05);(8)ROC曲线分析显示,VLP阳性改变联合LAC的敏感性为0.818,特异性为0.786。结论:脓毒症患者随着疾病严重程度增加,VLP阳性率、TQRS、LAS40越高,RMS40越低;脓毒症患者VLP阳性改变与预后有关,但不能作为判断患者预后的独立危险因素;VLP阳性改变联合LAC可以提高对判断脓毒症严重程度评估的敏感性。
[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，

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