title: [Effects of fluid resuscitation on myocardial injury in patients with severe sepsis and septic shock].
abstract: OBJECTIVE
  To observe the influence of fluid resuscitation on patients suffered from myocardial injury with severe sepsis and septic shock, and to evaluate the markers of myocardial injury during fluid resuscitation.
  
  
  METHODS
  Acute physiology and chronic health evaluation II (APACHE II) score of 78 patients with severe sepsis and septic shock induced by combined injuries was 18-35. Serum cardiac troponin I (cTnI), N-terminal-ventricular natriuretic peptide precursor (NT-proBNP) and the hemodynamic parameters were recorded before, 3 days, and 5 days after treatment, and correlative analysis was conducted.
  
  
  RESULTS
  Serum cTnI was increased in 62.8% (49/78) patients with severe sepsis and septic shock, and in 73.5% of patients (36/49) the increase was greater than 2-fold of the borderline value, and in 30.6% of patients (15/49) was greater than 4-fold of the borderline value. The patients with elevated serum NT-proBNP at admission accounted for 46.2% (36/78), and after fluid resuscitation treatment, patients with continuously rising value accounted for 74.4% (58/78). The serum cTnI, NT-proBNP, pulmonary arterial wedge pressure (PAWP) and cardiac index (CI) after treatment in survival group (55 cases) were obviously improved, and changes in them in non-survival group (23 cases) was not obvious. The serum cTnI (μg/L) and NT-proBNP (ng/L) levels in the non-survival group were distinctly higher than those of the survival group (cTnI 3 days: 2.09 ± 1.00 vs. 1.57 ± 0.93, 5 days: 1.78 ± 0.67 vs. 0.72 ± 0.51; NT-proBNP 3 days: 3.52 ± 0.73 vs. 3.16 ± 0.65, 5 days: 3.21 ± 0.66 vs. 2.66 ± 0.58), and CI [ml·s(-1)·m(-2)] was obviously lower than that of the survival group (3 days: 57.6 ± 6.2 vs. 68.3 ± 5.6, 5 days: 40.5 ± 4.7 vs. 80.7 ± 6.8, all P < 0.05). The cTnI level (μg/L) of 46 patients whose fluid resuscitation achieved the target was lower than that of the 32 cases without achieving the target (1.16 ± 0.62 vs. 1.97 ± 0.76, P < 0.05), and the CI [ml·s(-1)·m(-2)] was obviously increased (61.2 ± 6.4 vs. 49.3 ± 6.1, P < 0.05). The results suggested that whether the fluid resuscitation achieved the target or not was not related to changes in serum NT-proBNP and PAWP. A positive correlation was found between serum cTnI and NT-proBNP (r = 0.865, Y = 2.069 + 0.695X, P < 0.01), also between NT-proBNP and PAWP (r = 0.762, Y = 1.125 + 4.929X, P < 0.01), and a negative correlation was found between cTnI and CI (r = -0.891, Y = 50.623 - 6.114X, P < 0.01).
  
  
  CONCLUSIONS
  There is an obvious myocardial injury in the patient with severe sepsis and septic shock, and fluid resuscitation can improve the myocardial injury; the serum levels of cTnI and NT-proBNP are related to the prognosis of patients, but the significance of NT-proBNP guiding the fluid resuscitation can not be ascertained.
authors.affiliation: Emergency Department, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China.
authors.forename: Xin-liang
authors.initials: XL
authors.lastname: Zhang
authors.forename: Yan-jun
authors.initials: YJ
authors.lastname: Qin
authors.forename: Xiao-hua
authors.initials: XH
authors.lastname: Bian
authors.forename: Shi-min
authors.initials: SM
authors.lastname: Dong
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D005260:Female; D006335:Heart Injuries / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000628:therapy*; D012772:Shock, Septic / Q000097:blood / Q000209:etiology / Q000628:therapy*; D019210:Troponin I / Q000097:blood
chemical_list: D010446:Peptide Fragments; D019210:Troponin I