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目的:探讨脓毒症患者心率减速力(DC)改变与临床预后的相关性。方法:连续性纳入2014-01-2016-06我院收治的脓毒症患者124例,根据患者28d病死率分为死亡组(n=52)和存活组(n=72)。所有患者入组后进行急性生理和慢性健康(APACHE)Ⅱ和SOFA评分,给予动态心电图检测并计算DC值。结果:死亡组患者APACHEⅡ评分和SOFA评分明显高于存活组[(38.2±9.3)分vs.(27.2±6.1)分,P<0.05;(13.2±3.2)分vs.(8.1±2.3)分,P<0.05)],而DC明显低于存活组[(2.8±0.5)ms vs.(4.2±0.8)ms,P<0.05]。DC降低组患者ICU滞留时间和28d病死率明显高于DC正常组[(14.2±2.5)d vs.(10.3±3.1)d,P<0.05;55.3%vs.33.8%,P<0.05)]。DC预警28d死亡事件的AUC为0.832,95%CI为0.723~0.872,cut-off值为2.2ms,特异性为84.2%,敏感性为80.1%。DC水平与28d病死率(r=-0.611,P<0.05)和ICU滞留时间(r=-0.531,P<0.05)呈负相关。结论:DC水平降低与脓毒症患者病死率密切相关,是潜在的评价临床预后的预警指标。
Objective: To investigate the relationship between heart rate deceleration (DC) changes and clinical prognosis in sepsis patients. Methods: A total of 124 patients with sepsis admitted to our hospital from January 2014 to June 2016 were divided into death group (n = 52) and survival group (n = 72) according to their 28-day mortality. All patients were enrolled in the acute physiology and chronic health (APACHE) Ⅱ and SOFA score, given the dynamic electrocardiogram test and calculate the DC value. Results: The APACHE Ⅱ score and SOFA score in the death group were significantly higher than those in the survival group [(38.2 ± 9.3) vs (27.2 ± 6.1), P <0.05; (13.2 ± 3.2) vs. (8.1 ± 2.3) P <0.05), while the DC was significantly lower than the survival group (2.8 ± 0.5) ms vs. (4.2 ± 0.8) ms, P <0.05. The ICU retention time and mortality at 28 days in DC-reduced group were significantly higher than those in DC-normal group [(14.2 ± 2.5) d vs. (10.3 ± 3.1) days, P <0.05; 55.3% vs.33.8%, P <0.05). The AUC of DC 28d mortality was 0.832, the 95% CI was 0.723-0.872, the cut-off was 2.2ms, the specificity was 84.2% and the sensitivity was 80.1%. DC level was negatively correlated with the 28d mortality (r = -0.611, P <0.05) and ICU retention time (r = -0.531, P <0.05). Conclusion: The decrease of DC level is closely related to the mortality of patients with sepsis, which is a potential predictor of clinical prognosis.