The Characteristics And Value Of Ventricular Late Potentials In Septic Patients

Objective: To observe the characteristic of ventricular late potentials(VLP) in patients with sepsis and discuss its relationship with condition and prognosis.Methods: 115 patients with sepsis were collected in emergency medicine ward of Tianjin medical university general hospital between July 2014 and April 2015. They were divided into sepsis group, severe sepsis group and septic shock group according to the severity of disease and were divided into survival group and death group according to prognosis. The patients with sepsis and severe sepsis and septic shock met sepsis criteria according to 2001 SCCM/ESICM/ACCP/AIS/515 International Sepsis Definition Conferenee. Three group patients are monitored body temperature(T), heart rate(HR), mean arterial pressure(MAP), C-reaction protein(CRP), Procalcitonin(PCT), 24 h lactate clearance, arterial blood lactate(LAC),arterial partial pressure of oxygen(Pa O2), blood PH(p H), white blood cell(WBC),Troponin T(Tn T), Heart-type fatty acid-binding protein(H-FABP), Brain natriuretic peptide(BNP), Electrocardiogram(ECG), VLP, ultrasound cardiogram(UCG),APACHE II score,collect venous blood serum Tn T, H-FABPand BNP at six o 'clock respectively on 1st day, 3rd day and 7th day, and analysis the dynamic changes of VLP of different severity and prognosis of patients with sepsis.Spearman's correlation analysis and multivariate Logistic regression analysis-mapping receiver operating characteristic(ROC) curve and calculate the area under the curve analysis affect the prognosis of patients with sepsis risk factors and plasma Cortisol in patients with sepsis prognosis value, and to analyze the correlation of VLP, 24 h lactate clearance,LAC, PCT with APACHE II score.Results:(1)The comparison among sepsis group, the severe sepsis group and septic shock of patients age, gender, T, HR, MAP, Pa O, p H, the differences was not statistically significant(P> 0.05); CRP, PCT, 24 h lactate clearance, LAC, WBC, c Tn T,H-FABP, BNP, APACHE II score, the differences were statistically significant(P<0.05);(2)In the sepsis group, the VLP positive rate was 36.00%, while 51.42% in the severe sepsis group, and 66.67% in the septic shock group,and septic shock group which the VLP positive rate, TQRS, LAS40 showed significant higher than the other groups and RMS40 was lower than the other groups(p<0.05);(3)Three groups of VLP positive patients which TNT, H-FABP, BNP were higher than negative groups(P<0.05); Septic shock group of VLP negative and positive group which c Tn T, H-FABP,BNP concentrations were significantly higher than sepsis, severe sepsis of VLPnegative and positive group(P<0.05); With the development of disease and treatment,c Tn T, H-FABP, BNP concentration decreased, the seventh day of non-sepsis, sepsis VLP positive and negative groups which c Tn T, H-FABP, BNP concentration was no significant difference(P>0.05), but were lower than the septic shock group(P<0.05);(4)Septic shock group of VLP negative and positive patient group, LVEDV and LVESV were significantly higher than the other groups, SV and LVEF were significantly lower, the difference was statistically significant(P <0.05);(5)The positive rate, TQRS, LAS40 of death group were higher than the survival group,the RMS40 was lower, the difference was statistically significant(P<0.05);(6)VLP, 24 h lactate clearance, LAC, PCT and APACHE II were positively correlated according to Spearman's correlation analysis;(7)Simple factor analysis reveals that CRP, PCT, 24 h lactate clearance, LAC, WBC, Tn T, H-FABP, BNP, VLP and APACHEII are the risk factors of prognosis of septic patients(P<0.05). Multinomial Logistic regression analysis showed APACHE II score, 24 h lactate clearance, LAC, and PCT were the independent risk factors for the prognosis of septic patients.(P<0.05),but VLP was not included.(P>0.05);(8)The AUC analysis shows that the sensitivity of VLP combined with LAC was 0.818,and the specificity was 0.786.Conclusion: As the disease severity in patients with sepsis increased, VLP positive rate, TQRS, LAS40 were higher, RMS40 was lower; VLP is the risk factor of prognosis of septic patients, but not an independent risk factor for the prognosis; VLP combined with LAC can increase the sensitivity of the assessment to judge the sepsis..