严重多发伤患者心脏肌钙蛋白Ι与创伤评分、多脏器功能障碍综合征之间的关系

Relationship between dynamic changes of myocardial serum troponin I and injury scale and multiple organs dysfunction syndrome in severe multiple trauma patients

目的观察严重多发伤患者心脏肌钙蛋白Ι(cTnI),探讨其与创伤评分、多脏器功能障碍综合征之间的关系。方法将116例严重多发伤患者,根据有无合并胸部创伤分为两组:合并胸部创伤80例,无合并胸部创伤36例,进行ISS评分和胸部损伤定级(IS)。用微粒子免疫发光法采集血样检测cTnI浓度。结果观察116例多发伤患者中,cTnI升高37例,其中合并胸部创伤30例,无合并胸部创伤7例;cTnI峰值随ISS值升高明显前移且绝对值增高;严重多发伤合并胸部创伤患者cTnI值升高例数比例,随AIS值升高而升高,血清cTnI峰值比较,差异有显著性意义(p<0.05);伴有MODS患者的血清,cTnI水平为(8.48±5.22)ng/ml,且持续时间较长,并与MODS的严重程度呈正相关。结论严重多发伤患者出现心肌损伤以合并胸部创伤者为主,但严重多发伤患者无论胸部创伤与否均可出现心肌损伤,心肌损伤程度与MODS的发生率密切相关。

Objective To study the relationship between myocardial serum troponin I（cTnI）, injury severity score（ISS） and multiple organs dysfunction syndrome（MODS） in severe multiple trauma patients. Methods 116 cases of severe multiple trauma were divided into two groups： 80 cases with blunt chest trauma and 36 cases without. ISS and AIS in chest were performed in all cases. The concentration of cTnI was measured by microparticle - enzyme immunoassay. Results The concentration of cTnl increased in 30 patients with, in 7 ones without blunt chest trauma. In patients with blunt chest trauma or without, ISS was related to cTnI peak concentration （ r = 0. 816, p 〈 0.01 ）. The high concentration of cTnl in patients with MODS maintained long time and was related to the degree of MODS, Conclusion Incidence of the cardiac damage is more in the patients with blunt chest trauma than those without, Incidence of MODS is associated with the degree of cardiac damage.