108例急性一氧化碳中毒患者并发心肌损害分析

Analysis of myocardial damage after acute carbon monoxide poisoning in 108 cases

目的分析急性一氧化碳中毒(acute carbon monoxide poisoning,ACOP)时临床心电图表现、心肌酶及肌钙蛋白(cTNT)的改变对心肌损害的临床意义。方法对我院2008年11月～2012年12月收治的108例ACOP患者进行心电图、心肌酶及cTNT定量临床观察,并做回顾性分析。结果 108例ACOP患者均有不同程度意识障碍,昏迷82例,占75.9%;心电图异常80例,占74.1%,其中ST-T改变69例,占63.9%;心肌酶活性升高69例,占63.9%;cTNT活性升高25例,占27.8%。心电图的改变及心肌酶、cTNT的活性升高与年龄呈正比,与中毒程度呈正相关,差异有统计学意义,中、重度中毒与轻度中毒者,重度中毒与中度中毒者比较,差异均有统计学意义(P<0.01)。经治疗,101例患者康复出院,5例因中毒时间长合并多脏器功能衰竭死亡,2例发生一氧化碳中毒迟发性脑病。结论 ACOP可以造成心肌不同程度的损害,需要积极进行相应治疗。

Objective To study the clinical significance of change of electrocardiogram(ECG), myocardial enzymes and troponin (cTNT) for myocardial damage after acute carbon monoxide poisoning(ACOP). Methods Quantitative clinical observation and retrospective analysis about ECG,myocardial enzymes and cTNT of 108 patients who were diagnosed with ACOP between November 2008 and December 2012 in our hospital were carried out. Results Different degrees of disturbance of consciousness were found among 108 patients. In the observed group, coma was found in 82 cases(75.9%); electrocardiographic abnormality was found in 80 cases (74.1%), including ST-T change in 69 cases(63.9%). Among 108 ACOP patients, the increase of myocardial enzymes activity was found in 69 cases (63.9%); the increase of cTNT activity in 25 cases (27.8%). The change of ECG, activity increases of myocardial enzymes and cTNT are proportional to the age while has positive relationship with the degree of CO poisoning. There lies significant difference among 3 levels of ACOP. Compared with mild poisoning patients, severe and moderate ones have statistical significant, and so do severe poisoning patients comparing with moderate ones(P&lt;0.01). After treatment, 101 cases got fully recovered. However, 5 cases died of multiple organs failure and long poisoning time while 2 cases died of delayed encephalopathy after ACOP. Conclusion ACOP can cause myocardial damage in different degrees, which requires appropriate treatment.