儿童脓毒性心肌病的临床特征及发病危险因素分析

郭恩玉 房艳岭 耿化晓 王文杰 李姗姗 孟祥兰 张海防

【摘要】目的 探討脓毒症儿童合并脓毒性心肌病（SICM）的临床特征及发病危险因素，为提高临床医师的诊治水平提供参考。方法 回顾性分析脓毒症患儿的临床资料。按照是否发生SICM，将其分为SICM组和非SICM组，比较2组患儿的临床特点及转归，分析SICM发生的危险因素。结果 ①398例脓毒症患儿被纳入研究，其SICM发病率为15.58%（62/398）。SICM组年龄［49（18，108）个月］大于非SICM组［19（6，52）个月］，SICM组合并脓毒性休克比例［83.87%（52/62）］高于非SICM组［42.56%（143/336）］；SICM组病死率［29.03%（18/62）］高于非SICM组［14.58%（49/336）］，比较差异均有统计学意义（P < 0.05）。②多因素Logistic回归分析显示：年长儿发生SICM的风险更高（OR=1.010，95%CI 1.003～1.017，P = 0.006）；血乳酸水平越高，发生SICM的风险越高（OR=1.163，95%CI 1.034～1.308，P = 0.012）；肌钙蛋白水平越高，发生SICM风险越高（OR=9.929，95%CI 4.651～21.197，P < 0.001）。结论 与非SICM患儿相比，SICM患儿更易发生脓毒性休克，病死率更高。年龄、乳酸及cTnI为儿童SICM独立的影响因素。

【关键词】儿童；脓毒症；脓毒性心肌病；危险因素；临床特征；脓毒性休克

Clinical features and risk factors of sepsis-induced cardiomyopathy in children with sepsis

GUO Enyu1， FANG Yanling1， GENG Huaxiao1， 2， WANG Wenjie1， LI Shanshan1，MENG Xianglan1，ZHANG Haifang1

（1.Department of Pediatrics， Jining No.1 Peoples Hospital， Jining 272000， China； 2.Department of Pediatrics，

Affiliated Hospital of Jining Medical College， Jining 272000， China）

Corresponding author： ZHANG Haifang， E-mail： zhf971124@sina.com

【Abstract】Objective To investigate the clinical features and risk factors of sepsis-induced cardiomyopathy in children with sepsis， aiming to provide reference for enhancing the diagnosis and treatment levels of clinicians. Methods Clinical data of children with sepsis were retrospectively analyzed. All patients were divided into the sepsis-induced cardiomyopathy group and non-sepsis-induced cardiomyopathy group according to whether sepsis-induced cardiomyopathy occurred.Clinical characteristics and outcomes were compared between two groups. The risk factors of sepsis-induced cardiomyopathy were analyzed. Results Three hundred and ninty-eight children with sepsis were included in this study， and the incidence of sepsis-induced cardiomyopathy was 15.58%（62/398）. The age of children in the sepsis-induced cardiomyopathy group was 49 （18， 108） months， older than 19 （6， 52） months in the non-sepsis-induced cardiomyopathy group. The incidence of septic shock in the sepsis-induced cardiomyopathy group was 83.87%（52/62）， which was higher than 42.56% （143/336） in the non-sepsis-induced cardiomyopathy group. The mortality rate in the sepsis-induced cardiomyopathy group was 29.03% （18/62）， significantly higher than 14.58% （49/336） in the non-sepsis-induced cardiomyopathy group. All differences were statistically significant （all P < 0.05）.Multivariate Logistic regression analysis showed that the influence of age on sepsis-induced cardiomyopathy was statistically significant （OR=1.010， 95%CI 1.003-1.017， P = 0.006）. The higher the lactic acid level， the higher the risk of sepsis-induced cardiomyopathy， with statistical significance （OR=1.163， 95%CI 1.034-1.308， P = 0.012）. The higher the cTnI level， the higher the risk of sepsis-induced cardiomyopathy， with statistical significance （OR=9.929， 95%CI 4.651-21.197， P < 0.001）. Conclusions Compared with children with non-sepsis-induced cardiomyopathy， children with sepsis-induced cardiomyopathy are more prone to septic shock and have higher mortality. Age， lactic acid and cTnI levels are the independent influencing factors for sepsis-induced cardiomyopathy in children.

【Key words】 Children； Sepsis； Sepsis-induced cardiomyopathy； Risk factors； Clinical characteristics； Septic shock

脓毒症是由感染引起宿主炎症反应失调，进而发生危及生命MODS的危重症［1］。脓毒症引起的心功能障碍被称为脓毒性心肌病（SICM），发生SICM时机体的血液循环量明显減少，组织缺氧加剧，进而出现线粒体功能障碍，显著增加其他脏器功能障碍或衰竭的发生风险［2］。近年来，随着床旁即时超声检查在重症医学领域的广泛应用，SICM的特征也逐渐被认识，但其发病危险因素仍未明确。国内外关于成人SICM的研究显示，SICM与脓毒症病死率的增加密切相关［3-5］。关于儿童，Lautz等［6］报道，SICM是儿童脓毒症死亡的独立危险因素，但相关研究仍较少。为此，本研究回顾性分析了脓毒症患儿的临床资料，旨在探讨儿童SICM的临床特征及发病危险因素，为提高临床医师诊治儿童SICM的水平以及该病的管理提供参考。

1 对象与方法

1.1 研究对象

收集2015年1月1日至2022年12月31日在济宁市第一人民医院及济宁医学院附属医院儿童重症医学科（PICU）接受治疗的脓毒症患儿的临床资料。……