Effect Of Myocardial Injury On Mechanical Ventilation In Patients With Sepsis

ObjectiveBy analyzing the effect of sepsis with myocardial injury on weaning in patients with mechanical ventilation?mechanical ventilation days,length of hospitalization,weaning failure rate?,the indexes of myocardial injury,inflammation and blood gas which can predict the weaning outcome of septic patients with myocardial injury were selected as auxiliary indexes for clinical weaning,so as to reduce the pain,hospitalization time and treatment cost of patients.MethodsA retrospective analysis was made on 258 patients with sepsis admitted to the emergency intensive care unit?EICU?of our hospital from January 2005 to December2019.According to the standard of kit provided by the laboratory department of our hospital,the diagnostic criteria of septic myocardial injury were established as hs-cTnI?normal value?0.1ug/L?.They were divided into sepsis with myocardial injury?n=125?and sepsis non-myocardial injury group?n=133?.The basic disease,infection sites,acute physiology and chronic health evaluation II?APACHE II?score,sequential organ failure assessment?SOFA?score within 24 hours of admission,mechanical ventilation days and hospitalization days were recorded in detail.By conducting the weaning screening test,take the 90 minutes spontaneous breathing trial?SBT?to obtain the first weaning outcomes.And then analyze and compare statistically the first weaning outcome of the two groups of patients.At the same time,the age,sex,mechanical ventilation days,APACHE II score and SOFA score within 24 hours after admission,as well as the levels of PO₂,PCO₂,CK-MB,BNP,hs-cTnI and PCT were compared between the successful group and the failed group.Logistic regression analysis was used to explore the influencing factors of weaning outcome in patients with sepsis and myocardial injury.And the subject operating characteristic curve?ROC?was used to explore the predictive value of relevant indexes in the outcome of weaning in patients with septic and myocardial injury.Results1.In 125 patients with septic myocardial injury group,weaning was successful in 49 cases and failed in 76 cases.The failure rate of weaning in septic myocardial injury group was 60.8%?76/125?higher than that in septic non-myocardial injury group 47.3%?63/133??P<0.05?.The mechanical ventilation days and hospitalization days in the septic myocardial injury group were both higher than those in the septic non-myocardial injury group?both P<0.05?.2.Univariate analysis of the influencing factors of weaning outcome of sepsis with myocardial injury:there was no significant difference in age,sex,mechanical ventilation days,APACHE II score,SOFA score within 24 hours after admission and CK-MB levels between weaning successful group and failure group?P>0.05?The levels of hs-cTnI,BNP,PCO₂ and PCT in the weaning successful group were lower than those in the failure group,While the PO₂ in the weaning successful group was higher than that in failure group?all P<0.05?.Hs-cTnI,BNP,PO₂,PCO₂ and PCT were selected as the influencing factors of weaning outcome in sepsis with myocardial injury. 3.Logistic regression analysis of influential factors on the weaning outcome of sepsis with myocardial injury:Logistic regression analysis showed that hs-cTnI could not be used as a predictor of the weaning outcome of patients with sepsis and myocardial injury?P>0.05?,while BNP,PO₂,PCO₂ and PCT were all important predictors for the weaning outcome of septic patients with myocardial injury?all P<0.05?.4.The areas under the curve of BNP,PCT,PCO₂ and PO₂ were 0.871,0.736,0.693 and 0.635 respectively,and the area under the curve of BNP was the largest.Compared with the AUC of each other,there was no significant difference in the area under the curve of PO₂-PCO₂,PO₂-PCT and PCO₂-PCT?all P>0.05?.Otherwise,there were significant differences in AUC of BNP-PCT,BNP-PO₂ and BNP-PCO₂?all P<0.05?.By calculating the Youden index?Youden index=sensitivity+specificity-1?,it was found that the BNP had the largest Youden index corresponding to 295.04ng/L.The sensitivity and specificity of weaning failure in the prediction of septic myocardial injury were 82%and 96%,respectively.The maximum PO₂Youden index corresponds to 100.27mm Hg,with a sensitivity of 83% and a specificity of 46%.PCO₂ has the largest Youden index at 37.12mm Hg,with a sensitivity of 76%and a specificity of 53%.When the PCT Youden index was the largest,it corresponded to 3.07ng/ml,with a sensitivity of 53%and a specificity of 98%for predicting weaning failure.Data analysis showed that BNP,PO₂,PCO₂ and PCT were all important predictors of weaning outcomes in septic patients with myocardial injury.While BNP had higher predictive value than PO₂,PCO₂ and PCT in weaning outcomes in septic patients with myocardial injury.Conclusions1.The weaning failure rate of septic patients with myocardial injury was higher than that of sepsis patients without myocardial injury,and the days of mechanical ventilation and hospitalization were higher than those of sepsis patients without myocardial injury.2.Hs-cTnI can not be used as a predictor of weaning outcome in septic patients with myocardial injury,but BNP,PO₂,PCO₂ and PCT are all important predictors of weaning outcome in septic patients with myocardial injury,and BNP is more valuable than PO₂,PCO₂ and PCT in predicting weaning outcome in septic patients with myocardial injury.