脓毒症新发心律失常的临床调查
Investigation on new-onset arrhythmias in patients with sepsis

周淑清.脓毒症新发心律失常的临床调查[J].内科急危重症杂志,2019,25(6):478-481

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DOI：10.11768/nkjwzzzz20190611

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基金项目:辽宁省科学技术基金(No:2019-ZD-0416)

作者	单位	E-mail
周淑清	辽宁省人民医院	zsqst@126.com

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中文摘要:

目的：探讨脓毒症新发心律失常的发生率、危险因素及其对预后的影响。方法：回顾性分析542例脓毒症患者的临床资料，根据是否新发心律失常，将患者分为新发心律失常组和非新发心律失常组，统计脓毒症患者新发心律失常的发生率、心律失常类型、住监护病房时间和28d病死率，对新发心律失常可能的危险因素进行单因素和多因素回归分析。结果：542例脓毒症患者中158例新发心律失常，发生率29.15％。新发心律失常组急性生理学和慢性健康状况（APACHEⅡ）评分高于非新发心律失常组，住监护病房时间长于非新发心律失常组（均P<0.01)。单因素和多因素回归分析显示:年龄（OR=1.794，95％CI：1.166~2.760）、呼吸衰竭（OR=3.113，95％CI：0.744~13.022）、心力衰竭（OR=1.723，95％CI：0.970~3.059）、代谢紊乱（OR=2.459，95％CI：1.449~4.173）、急性肾损伤（OR=1.743，95％CI：0.978~3.106）、持续肾脏替代治疗（CRRT）（OR=5.951，95％CI：2.363~14.986）、机械通气（OR=16.713，95％CI：8.244~33.882）、儿茶酚胺药物使用（OR=6.472，95％CI：3.330~12.577）和凝血功能障碍（OR=6.686，95％CI：3.315~13.485）是脓毒症患者新发心律失常的危险因素。新发心律失常组病死率高于非新发心律失常组（51.27％ vs 39.84%, P<0.05）。结论：脓毒症患者新发心律失常的发生率高，年龄、器官功能障碍、机械通气、CRRT及儿茶酚胺药物使用均是危险因素，新发心律失常延长了患者住监护病房时间，增加了28d病死率。

英文摘要:

Objective: To investigate the incidence, risk factors and outcomes of new-onset arrhythmia in patients with sepsis. Methods: Clinical data of 542 patients with sepsis were analyzed retrospectively. Patients were divided into new-onset arrhythmia group and non-new-onset arrhythmia group. The incidence, intensive care unit (ICU) stay and 28-day mortality of new-onset arrhythmia in patients with sepsis were calculated. Univariate analysis and multivariate logistic analysis were performed on the possible risk factors of new-onset arrhythmia. Results: Among the 542 patients with sepsis, 158 of them had new-onset arrhythmia with the incidence being 29.15%. The APACHII score was higher in new-onset arrhythmia group than that in non-new-onset arrhythmia group, and ICU stay was longer than non-new-onset arrhythmia group (all P＜0.01). The statistical analysis showed that old age (OR=1.794, 95% CI: 1.166-2.760), respiratory failure (OR=3.113, 95% CI: 0.744-13.022), heart failure (OR=1.723, 95% CI: 0.970-3.059), metabolic disorder (OR=2.459, 95% CI: 1.449-4.173), acute kidney injury (OR=1.743, 95% CI: 0.978-3.106), continuous renal replacement therapy (CRRT) (OR=5.951, 95% CI: 2.363-14.986), mechanical ventilation (OR=16.713, 95% CI: 8.244-33.882), catecholamine drug (OR=6.472, 95% CI: 3.330-12.577) and blood coagulation dysfunction (OR=6.686, 95% CI: 3.315-13.485) were risk factors for sepsis patients developing new-onset arrhythmia. The mortality of new-onset arrhythmias group was higher than that of non-arrhythmia group was (51.27% vs 39.84%, P＜0.05). Conclusion: The incidence of new-onset arrhythmias in patients with sepsis was high. Old age, organ dysfunction, mechanical ventilation, CRRT and catecholamine are all risk factors. New-onset arrhythmias not only extended the ICU stay, but also increased the fatality rate for 28 days.