The Effects Of Sepsis Myocardial Depression On Hemodynamic And Organ Function And The Prognosis Of Septic Shock Patients

Objective: Sepsis myocardial depression is a reversible myocardial dysfunction. It can damage both cardiac function and structure,resulting in decreased cardiac contractility and cardiac output(CO), which can not meet the vital organs perfusion, even causing cardiogenic shock and death. However, we lack reliable evidence about effects of sepsis myocardial depression on the body at present. This study aims to disuss the effects of sepsis myocardial depression on hemodynamic and organ function and the prognosis of septic shock patients through comparing the data of patients with sepsis myocardial depression or not.Methods: Patients who were diagnosed septic shock were enrolled in the study from June 2015 to December 2016 in ICU of the fourth hospital of Hebei Medical University. 32 patients in all were enrolled in the study at first, but 29 patients were enrolled at last because of various reasons. Once admitted in ICU, the patients were checked by echocardiography,if the reduction of cardiac function and/or ventricular wall oedema is found, at the same time the EF deteriorated to 50%, then patients were defined as sepsis myocardial depression, if not the patients were defined as being without sepsis myocardial depression. According to the ocurrence or not of sepsis myocardial depression, patients were assigned to the sepsis myocardial depression group and non sepsis myocardial depression group. Two groups of patients were both performed PICCO hemodynamic monitoring and gave fluid resuscitation, anti-infection and a series of support treatments according to the 2012 SSC guidelines.In the fist day, third day and seventh day, we should record echocardiography values(LVEF LVEDD RVEDD PAP E/A)and PICCO hemodynamic parameters(CVP MAP CI SI SVRI ITBVI GEDVI EVLWI PVPI dp/dt max)and the organ function indicators(PLT INR PaO2/FiO2 SCr TBil),then compare the hemodynamics and organ functions and the prognosis between two groups at last.Results:1 There were 29 patients in the research at last. There were 16(55.2%) patients in the non sepsis myocardial depression group and 13(44.8%)patients in the sepsis myocardial depression group.The mean age was 65.8±8.8 years;There were 16 male patients( 55.2%),13 female patients(44.8 %);The APACHII score was23.6±4.5;The SOFA score was17±5.0;Infections include 18 cases of pulmonary infection(62.1%),6 patients with pleural infection(20.7%),2 cases of abdominal cavity infection(6.9%),1 case of blood stream infection(3.4%) and2 cases of wound infection(6.9%).2 Comparence of general condition between two groups Except SOFA in the sepsis myocardial depression group was higher(P=0.02),No matter age height weight and APACHE II score,there were no statistical differences between two groups(P=0.42,P=0.11,P=0.22,P=0.13).3 Comparence of hemodynamics parameters echocardialgraphy values and myocardial injury markers between two groups There were statistical differences between two groups in LVEF dp/dt max in the fist day(P=0.01,P=0.02),but other indexes HR(P=0.75) CVP(P=0.17) MAP(P=0.53) CI(P=0.35) SI(P=0.95) SVRI(P=0.29) ITBVI(P=0.98) GEDVI(P=0.81) EVLWI(P=0.62) PVPI(P=0.62) PAP(P=0.56) LVEDD(P=0.71) RVEDD(P=0.95) TnI(P=0.12) had no statistical differences between two groups. Compared between two groups, except LVEF dp/dt max,there were significantly statistical differences in myocardial injury marker TnI in the third day,Other variables HR(P=0.88) CVP(P=0.65) MAP(P=0.18) CI(P=0.65) SI(P=0.45) SVRI(P=0.95) ITBVI(P=0.98) GEDVI(P=0.78) EVLWI(P=0.85) PVPI(P=0.71) PAP(P=0.48) LVEDD(P=0.95) RVEDD(P=0.85) had no statistical differences.In the sevevth day,dp/dt max was lower in the patients with sepsis myocardial depression(P=0.01),TnI was higher in the same patients(P=0.04), but other parameters HR(P=0.59) CVP(P=0.22) MAP(P=0.0.53) CI(P=1.0)、SI(P=0.91) SVRI(P=0.81) ITBVI(P=0.45) GEDVI(P=0.91) EVLWI(P=0.71) PVPI(P=0.50) PAP(P=0.91) LVEDD(P=0.62) RVEDD(P=0.88) had no statistical differences.There were no statistical differences in E/A in any time(P=0.90,P=0.30,P=0.10). We did not find any statistical differences in BNP in any time too(P=0.16, P=0.45, P=0.85).4 Comparence of organ functions between two groups Compared with no sepsis myocardial depression groups, there were more dysfunctioned organs in the sepsis myocardial depression group(P=0.03),and the SOFA score was relatively high(P=0.02). There were statistical differences between two groups in oxygenation(P=0.04,P=0.04)in the fist and third day,otherindexes,WBC(P=0.42,P=0.98,P=0.78)PCT(P=0.40,P=0.11,P=0.11);PLT(P=0.66,P=0.85,P=0.95);INR(P=1.0,P=0.78,P=0.81);SCr(P=0.91,P=0.98,P=0.13);TBil(P=0.53,P=0.85,P=0.85)had no statistical differences between two groups.5 Comparence of prognosis between two groupsThe main outcomes The survival rates of patients sepsis myocardial depression was61.5%(8/13)and the survival rates of patients without sepsis myocardial depression was 81.3%(13/16),there were no statistical differences between two groups(χ2=0.583,P=0.445).The secondary outcomes The patients accepted same time of mechanical ventilation and blood purification(P=0.16, P=0.13). Patients with sepsis myocardial depression stayed in ICU for longer time(P=0.04).Conclusions:1 Compared with patients without sepsis myocardial depression,there were some statistical diffences in LVEF and dPmx.2 Through comparence, patients with myocardial depression had more dysfunction organs and stayed longer in ICU.3 Sepsis myocardial depression has no effect on the 28 th survival rate of septic shock patients.