| 脓毒症患者中横纹肌溶解综合征与预后关系的研究 |
| 投稿时间：2016-09-17 修订日期：2016-10-10 点此下载全文 |
| 引用本文：龚雪,张丹,李鹏飞,曾燕,魏伏,许珊,董瑞安.脓毒症患者中横纹肌溶解综合征与预后关系的研究[J].医学研究杂志,2017,46(5):35-38,47 |
| DOI：
10.11969/j.issn.1673-548X.2017.05.010 |
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| 基金项目:国家自然科学基金资助项目（面上项目）（81071531、81372102）；重庆市自然科学基金资助项目（面上项目）（CSTC2009BB5066） |
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| 中文摘要:目的 探讨脓毒症患者中横纹肌溶解综合征（RM）与病情严重程度及预后的关系。方法 采用前瞻性研究方法，入选2014年10月~2015年9月重庆医科大学附属第一医院中心ICU连续收治的脓毒症患者151例作为研究对象。检测入ICU当天的血清肌酸激酶（CK），以CK≥1000U/L作为RM的诊断标准，比较发生RM的患者与未发生RM患者的感染标志物、危重症评分、器官功能障碍和28天病死率等。结果 151例脓毒症患者中37例（24.5%）发生RM。RM组的PCT水平、APACHEⅡ评分和SOFA评分较非RM组高（P<0.05）。RM组ICU期间肝脏功能障碍、循环障碍、肾脏功能障碍的发生率、人均器官障碍数、血肌酐峰值水平、接受连续肾脏替代治疗（CRRT）患者的比例和28天病死率较非RM组高（P<0.05），而呼吸功能障碍、凝血功能障碍和神经系统障碍的发生率比较，差异无统计学意义（P>0.05）。CK对预测脓毒症患者28天死亡风险具有统计学意义，ROC曲线下面积（AUC）为0.694（P<0.05），低于APACHEⅡ评分（0.841）和SOFA评分（0.805）（P<0.05）。结论 脓毒症患者中RM的发生率高，发生RM的患者的病情更危重，其ICU期间肝脏功能障碍、循环障碍、肾脏功能障碍的发生率和28天病死率均显著增加，CK可以作为预测脓毒症患者28天病死率的参考指标。 |
| 中文关键词:横纹肌溶解综合征 脓毒症 肌酸激酶 预后 器官功能障碍 |
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| Relationship Between Rhabdomyolysis and Prognosis in Septic Patients |
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| Abstract:Objective To explore the relationship between rhabdomyolysis(RM) and severity as well as prognosis in septic patients. Methods A total of 151 patients with sepsis continuously admitted to the Intensive Care Unit(ICU) between October 2014 and September 2015 were included in this prospective study. Venous blood samples of patients were drawn to detect serum concentration of creatine kinase(CK). According to the diagnosis criteria of RM (CK≥1000U/L),patients were divided into: RM group(n=37)and non-RM group(n=114).Infection markers,critical illness score,the incidence rate of organ dysfunction during ICU and 28-day mortality were compared between the two group. Results Overall rate of RM was 24.5% in septic patients.Compared with non-RM group,serum levels of procalcitonin(PCT), APACHEⅡ score and SOFA score were higher in RM group(P<0.05). In patients with RM, the incidence rate of hepatic dysfunction, hemodynamic dysfunction, renal dysfunction, organ dysfunction per person, peak value of serum creatinine, the rate of continuous renal replacement therapy(CRRT) and 28-day mortality were higher than those in patients without RM(P<0.05),while the incidence rate of respiratory dysfunction, hematologic dysfunction,and neurologic dysfunction during ICU showed no significant difference in two groups(P>0.05). CK had statistical significance in predicting 28-day mortality,and area under ROC curve was 0.694(P<0.05),which was lower than APACHEⅡ score(0.841) and SOFA score(0.805)(P<0.05). Conclusion The incidence rate of RM in septic patients was high. Septic patients with RM were more severe. The incidence of RM was associated with hepatic dysfunction, hemodynamic dysfunction, renal dysfunction during ICU and 28-day mortality in septic patients. CK may be used as reference index for predicting 28-day mortality of septic patients. |
| keywords:Rhabdomyolysis Sepsis Creatine kinase Prognosis Organ dysfunction |
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