脓毒症患者新发心房颤动的危险因素及其对预后的影响研究

doi:10.12114/j.issn.1007-9572.2019.00.119

摘要/Abstract

摘要： 背景　心房颤动是脓毒症患者最常见的临床表现之一，其不仅加重患者病情，还可导致预后不良。但目前对脓毒症患者新发心房颤动的研究尚不多。目的　探讨脓毒症患者新发心房颤动的危险因素及其对预后的影响。方法　回顾性选取2016年1月—2017年12月辽宁省人民医院重症监护病房（ICU）、急诊监护病房（EICU）、呼吸监护病房（RICU）诊断为脓毒症或脓毒性休克的患者542例为研究对象。其中新发心房颤动82例（15.1%，新发心房颤动组），无新发心房颤动460例（84.9%，非新发心房颤动组）。对比分析两组患者临床资料和预后指标，分析脓毒症患者新发心房颤动的影响因素。结果　新发心房颤动组年龄和器官功能障碍中的急性肾损伤、心力衰竭、代谢紊乱、凝血功能障碍、呼吸衰竭发生率及机械通气率、连续性肾脏替代治疗（CRRT）率、儿茶酚胺药物使用率、急性生理学及慢性健康状况评分系统（APACHEⅡ）评分大于非新发心房颤动组（P<0.05）。多因素Logistic回归分析结果显示，年龄〔OR=1.038，95%CI（1.013，1.063）〕和器官功能障碍中的急性肾损伤〔OR=2.142，95%CI（1.035，4.432）〕、代谢紊乱〔OR=2.071，95%CI（1.083，3.959）〕、凝血功能障碍〔OR=7.621，95%CI（3.236，17.945）〕及CRRT情况〔OR=6.567，95%CI（2.306，18.705）〕、儿茶酚胺药物使用情况〔OR=6.683，95%CI（3.224，13.853）〕是脓毒症患者新发心房颤动的影响因素（P<0.05）。两组28 d死亡率比较，差异无统计学意义（P>0.05）；新发心房颤动组住监护病房时间长于非新发心房颤动组（P<0.05）。结论　脓毒症患者新发心房颤动的发生率高，年龄越大和发生器官功能障碍中的急性肾损伤、代谢紊乱、凝血功能障碍及接受CRRT、使用儿茶酚胺药物是脓毒症患者新发心房颤动的危险因素，新发心房颤动延长了脓毒症患者住监护病房时间，但并未增加其28 d死亡率。

关键词: 脓毒症；休克, 脓毒性；心房颤动；危险因素；预后

Abstract: Background　Atrial fibrillation is one of the most common clinical manifestations in patients with sepsis，which can aggravate the severity of the patient's condition，and even cause adverse prognosis.However，there are few studies on new-onset atrial fibrillation in sepsis.Objective　 To identify the risk factors and prognostic impact of new-onset atrial fibrillation in sepsis.Methods　A retrospectively study was conducted on 542 cases of sepsis recruited from the ICU，EICU and RICU of the People's Hospital of Liaoning Province from January 2016 to December 2017，including 82（15.1%）with new-onset atrial fibrillation and 460（84.9%）without.Clinical and prognostic data were collected.And factors associated with new-onset atrial fibrillation were analyzed.Results　 Sepsis patients with new-onset atrial fibrillation showed higher rates of having acute renal injury，heart failure，metabolic disorder，coagulation disorders，respiratory failure，mechanical ventilation，continuous renal replacement therapy（CRRT），and catecholamine use，and higher mean APACHE Ⅱ core compared with those without（P<0.05）．Multivariate Logistic regression analysis demonstrated that，age〔OR=1.038，95%CI（1.013，1.063）〕，acute kidney injury associated with multiple organ dysfunction syndrome〔OR=2.142，95%CI（1.035，4.432）〕，metabolic disorder〔OR=2.071，95%CI（1.083，3.959）〕，coagulation disorders〔OR=7.621，95%CI（3.236，17.945）〕，use of CRRT〔OR=6.567，95%CI（2.306，18.705）〕 and use of catecholamines〔OR=6.683，95%CI（3.224，13.853）〕 were factors associated with new-onset atrial fibrillation in sepsis（P<0.05）．There was no significant difference in 28-day in-hospital mortality between the two groups（P>0.05）．The length of ICU stay was longer in new-onset atrial fibrillation group than that of non-new-onset atrial fibrillation group（P<0.05）．Conclusion　The incidence of new-onset atrial fibrillation in patients with sepsis was high.Old age，acute kidney injury associated with multiple organ dysfunction syndrome，metabolic disorder，coagulation disorders，use of CRRT，and use of catecholamines were independent risk factors for new-onset atrial fibrillation.New-onset atrial fibrillation extended the length of ICU stay，but did not increase the 28-day in-hospital mortality.

Key words: Sepsis；Shock, septic；Atrial fibrillation；Risk factors；Prognosis

周淑清,沈涛. 脓毒症患者新发心房颤动的危险因素及其对预后的影响研究[J]. 中国全科医学, 2019, 22(24): 2929-2932. DOI: 10.12114/j.issn.1007-9572.2019.00.119.
ZHOU Shuqing,SHEN Tao. Risk Factors and Prognostic Impact of New-onset Atrial Fibrillation in Patients with Sepsis　[J]. Chinese General Practice, 2019, 22(24): 2929-2932. DOI: 10.12114/j.issn.1007-9572.2019.00.119.

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