Clinical Study Of Myocardial Injury Caused By Septic Shock

ObjectiveSeptic shock is common disease in the department of intensive care unit(ICU),which could lead to multiple organ dysfunction.Inhibition of myocardial function caused by septic shock directly,it causes a decrease in cardiac pump function and a decrease in cardiac output,leading to heart failure and threatening the life of the patient eventually.The clinic study investigated the predisposing factors and prognostic factors of myocardial injury in patients with septic shock.MethodsThis group of patients met the diagnostic criteria for septic shock,and the serum troponin(cTnI)was 2 times greater than the baseline,and the N-terminal B-type natriuretic peptide precursor(NT-proBNP)≥1800 pg/ml diagnostic criteria.And exclude the primary disease of rhabdomyolysis syndrome,acute coronary syndrome,aortic dissection,other causes of acute decompensated heart failure,malignant arrhythmia,acute pulmonary embolism,status epilepticus,pregnancy,chemotherapy drugs Patients with cardiotoxic injuries.94 patients with septic shock who were admitted to the Department of Critical Care Medicine of Anhui Provincial Hospital from July 2015 to March 2018 were enrolled.The patients were divided into myocardial injury group and non-myocardial injury group according to whether myocardial injury occurred.Analysis of body temperature,mean arterial pressure,central venous pressure,24h urine volume,arterial blood lactate,white blood cell count,neutrophil ratio,C-reactive protein,procalcitonin,cTnI,myoglobin,N-terminal B-type natriuretic peptide precursor,serum creatinine and other indicators.Statistical analysis was performed using t test,rank sum test,χ~2 test,Spearman correlation analysis,and multivariate logistic regression analysis.Result⑴Of the 94 patients with septic shock admitted to the ICU,56 were male and 38 were female,aged 34-95(69.66±17.03)years old.The age of patients with myocardial injury was 79.00(65.00,85.20),and that of non-myocardial injury group was 66.00(50.00,87.50).The older patients were more likely to have myocardial injury.The primary infection was 72 cases(76.60%)of the respiratory system.14cases(14.89%),8 cases of central nervous system(accounting for 8.51%).⑵Univariate analysis showed that serum albumin was admitted to the hospital,and CVP(Central venous pressure,CVP),LDH(Lactic dehydrogenase,LDH),cTnI,NT-proBNP and SOFA scores were diagnosed in patients with septic shock Larger(P<0.05).Multivariate logistic regression analysis showed that hypoproteinemia and high SOFA scores were independent risk factors(P<0.05).⑶Of the 94 patients with septic shock,52 died,and the mortality rate was 55.32%.The myoglobin(MYO)and NT-proBNP in the death group were higher than those in the survival group(P<0.05).The creatine kinase(CK)in the death group was significantly higher than the survival group(P<0.05).⑷Patients with cTnI and aspartate aminotransferase(AST),alanine aminotransferase(ALT),aspartate aminotransferase mitochondrial isoenzyme(mAST),LDH,NT-proBNP,Glutamine transpeptidase(GGT)and MYO were positively correlated(r=0.338,0.304,0.275,0.389,0.549,0.343,0.419,P=0.003,0.015,0.018,0.003,<0.001,0.003,<0.001),When septic shock was diagnosed,cTnI was positive correlation with CVP,NT-proBNP,AST,ALT,LDH,but was negative correlation with serum albumin(r=0.347,0.228,0.440,0.485,0.380,-0.359,P=0.001,0.031,<0.001,<0.001,<0.001,0.001).Conclusion Patients with high age are more likely to suffer from myocardial injury,and the mortality rate of patients with myocardial injury caused by septic shock is as high as 55.32%.Low proteinemia and high SOFA score are independent risk factors for patients with myocardial injury caused by septic shock.Myocardial injury often occurs simultaneously with liver,skeletal muscle and mitochondrial damage;blood MYO,NT-proBNP,cystatin C in the course of disease.A significant increase in the SOFA score indicates a poor prognosis for the patient.