损伤严重度与心肌肌钙蛋白I变化的临床研究

Study on relationship of dynamic changes of cardiac troponin I with traumatic severity

目的探讨创伤患者心肌损伤的发生率以及心肌肌钙蛋白I（cTnI）变化与损伤严重度的关系。方法将326例创伤患者按简明损伤定级与损伤严重度记分（AIS90-ISS）法分为轻伤组、重伤组及严重伤组，于入院时、第3天、第7-10天测定血清cTnI含量，并同时进行心电图检查。结果创伤早期（伤后3d内），轻伤组的血清cTnI含量变化不是很明显，第3天的异常率仅为9．4％，重伤组及严重伤组血清cTnI含量变化比较明显，异常率分别为31．2％、69．0％；严重伤组的血清cTnI〉0．20μg／L例数达28例，即达到了心肌缺血阳性界值率为66．7％，且持续时间长。血清cTnI含量于第3天达高峰，第7-10天明显下降；不同AIS90-ISS评分患者的血清cTnI、心电图比较差异有统计学意义（P〈0．05或〈0．01）。结论创伤早期可并发心肌损伤，且损伤程度与创伤严重度有相关性，cTnI的测定对诊断心肌损伤、判断病情严重度和评价预后都有一定的作用。

Objective To explore the incidence rate of myocardial injury of the patients with trauma, and relationship of dynamic changes of cardiac troponinI（cTnI） with traumatic severity. Methods According to the AIS90-ISS, 326 trauma patients were divided into three groups： mild trauma group （AIS90 - ISS≤ 16 points） ,severe trauma group（ 16 points 〈 AIS90 - ISS 〈 25 points） and special severe trauma group （AIS90 - ISS≥25 points）. The levels of cTnI and changes of ECG were detected at enter hospital in time, the 3rd day and the 7th to 10th day after who were enrolled. Results At early stage （within 3 days after trauma） ,the changed of cTnI in serum were not obvious in the mild trauma group,abnormal rate was only 9.4%. However it changes obviously in the severe trauma group and special severe trauma group, abnormal rate was 31.2% and 69.0%. Twenty-eight cases in the special severe trauma group were increased to the positive value of myocardial isehemia （cTnI 〉 0.20 μ g/L）, peaked on the 3rd day after trauma, the time of keeping high was long. It returned to the normal level after the 7th to 10th day of trauma. There was significant difference of the levels of cTnI and changes of ECG in different AIS90-ISS groups （P 〈 0.05 or 〈 0.01 ）. Conclusion It is clear that trauma may complicate myocardial injury in early phase, but the degree of which relates with injury severity. The dynamic measurement of cTnI in serum has important significance for the diagnosis of myocardial injury and judging injury condition and evaluate prognosis in clinic.