危重病患者心肌肌钙蛋白Ⅰ测定的临床意义

Unrecognized myocardial injury in criticall illness patients

目的 探讨危重病患者隐匿性心肌损伤的发生率以及心肌肌钙蛋白I(cTnI)在评价危重病患者预后中的作用。方法 通过检测159例危重病患者血清cTnI的水平,利用回顾性双盲的单中心研究方法,分析危重病(呼吸衰竭、脑血管意外、心力衰竭等)患者cTnI与心肌损伤、机械通气时间、ICU住院时间和死亡率的关系。结果 在159例危重病患者中有34例(21.4％)患者存在cTnI的升高,但34例患者中只有9例(26.5％)被诊断存在心肌梗死,有25例患者并未发现有明显的心肌损伤。cTnI升高患者的死亡率远远高于cTnI未升高的患者(41.2％vs 16.0％),机械通气的发生率(58.8％vs 23.2％)和持续时间(7.9 vs 3.1 d)也大大增加,ICU住院时间也明显延长(10.8 vs 4.3 d)。结论cTnI水平的升高表明危重病患者中并发心肌损伤和功能失调的发生率很高,特别是许多心电图正常的隐匿性心肌损伤。cTnI作为心肌损伤的特异性标志物,在评价危重病患者的预后中也发挥重要作用。特别cTnI水平升高患者的死亡率、心肌损伤、机械通气的发生率、ICU住院时间等方面都明显增加。

Objective To determine the incidence and effect of unrecognized cardiac injury in critical illness patients and evaluate the significance of elevations of serum troponin I in critical illness patients. Methods We measured the level of serum troponin I and evaluated relationship between elevations of serum troponin I and myocardial injury, mechanical ventilation, intensive care unit stays by means of retrospective chart review and analysis of clinical data. Results Thirty - four(21.4% )of the 159 patients had evidence of myocardial injury based on elevated levels of cardiac troponin I, only 9(26.5%) of these 34 patients were diagnosed as acute myocardial infaction by the intensive care unit staff. Mortality [unrecogniazed(41.2% ) or recognized (44.4% ) ] was higher in the patients with myocardial injury than in the patients without myocardial injury( 16.0%) ( P < 0.01) .Patients with myocardial injury needed more frequently mechanical ventilation (58.8% vs 23.2%; P <0.001)and longer intensive care unit stays(10.8 vs 4.3 days; P <0.001)than those without myocardial injury. Conclusion The incidence of myocardial injury and dysfunction defined by elevated levels of cardiac troponin I was unexpectedly high and associated with mortality, mechanical ventilation, intensive care unit stays. It is likely that a high number of these myocardial necrosis may go unnoticed on the ECG.