危重病人心肌损伤的临床观察

The Clinic Observation of Myocardial Injury in Critically Ⅲ Patients

目的:证实非心源性疾病的危重病人在低血压事件后会发生心肌损伤,并寻找心肌坏死指标。方法:综合ICU脓毒症及脓毒休克的病人按预后分为两组。发生低血压事件后4～12小时内检测心肌肌钙蛋白-Ⅰ(cTn Ⅰ)、肌酸激酶(CK)、肌酸激酶同功酶(CKMB),动态观察ECG。结果:32例病人死亡18例,存活14例,死亡组cTnⅠ阳性率显著高于存活组(100％VS 35.7％,P<0.01)。32例病人cTnⅠ阳性率显著高于ECG阳性率(71.9％VS 31.3％,P<0.05)。另外,发生低血压的28例病人cTnⅠ阳性率与低血压持续时间呈正相关。结论:急性非心源性疾病的危重病人发生低血压后可以出现心肌损害,表现为cTnⅠ阳性,且心电图大多并未表现出心肌坏死特征。

Objective: To ascertain, after an episode of hypotension, myocardial necrosis could occur in critical care patients with acute non-cardiac illness and to search for signs of cardiac necrosis. Methods: Thirty-two patients of general intensive care unit (ICU) with severe sepsis /septic shock in two groups by outcome. Cardiac troponin Ⅰ (cTnI), creatine kinase (CK), ereatine kinase MB(CKMB) were measured at 4～12h after hypotension episode. And the ECG were observed continuously with 24h from enrollment. Results: The sensitivity of cTnI of death group were 100%, which were significantly higher than that of survivor group(35.7%, respectively, P<0.01). The sensitivity of cTnI of 32 patients was significantly higher than that of ECG(71.9% VS 31.3%, respectively, P<0.01). Moreover, the longer the hypotension episode was, the greater was the sensitivity of cTnI (moderate hypotension: 50% ; severe hypotension: 100%, P<0.01). Conclusions: Hypotension may cause cardiac damage in critically ill patients with acute non-cardiac diseases as shown by positive of cTnI. It is likely that a high number of these myocardial necrosis may go unnoticed on the ECG.