急性一氧化碳中毒患者心肌肌钙蛋白I测定的临床意义

The Clinical Significances in Cardiac TroponinI(TnI) of Patients with Acute Carbon Monoxide Poisoning

目的探讨急性一氧化碳中毒(ACOP)患者心肌肌钙蛋白I(TnI)的变化及临床意义。方法测定156例ACOP患者的TnI水平,按其结果分为TnI阳性组76例和TnI阴性组80例,分析ACOP患者TnI与心肌损伤发生率、机械通气发生率和EICU住院时间的关系。结果TnI阳性组中有42例患者有心脏事件(心绞痛、心律失常)的发生,发生率为55.3%,TnI阴性组有11例,发生率为13.8%,明显低于阳性组(P<0.01),TnI阳性组机械通气的发生率为(52.6%),比TnI阴性组(23.8%)高,差异具有显著性(P<0.05),TnI阳性组EICU住院时间(6.51±1.59)d明显高于TnI阴性组(4.96±1.49)d,差异具有显著性(P<0.05)。结论TnI对诊断微小心肌损伤具有高度敏感性和特异性,ACOP患者TnI升高,表明心脏事件的发生率和机械通气的发生率增高,EICU住院时间延长,TnI可作为反映病情严重程度和评估预后的一项参考指标。

Objective To investigate the changes and the clinical significances in cardiac troponinI（TnI） of patients with acute carbon monoxide poisoning. Methods We determined the level of Tnl of 156 patients with acute carbon monoxide poisoning,then according to the results, separate them into one group of TnI positive,including 76 patients, and another group of TnI negative, including 80 patients. Analyze the relation of the time in EICU and the probabilities of heart injury and mechanical ventilation. Results in the TnI positive patients, heart cases（angina pectoris、arrhythmia）happened on 42 of the 76 patients, the probability is 55.3%, while the same situation is obviously less than in the TnI negative patients with the probability of 13.8%（P〈0.01）. Meanwhile, there exists a great differenc（eP〈0.05） between the probabilities of mechanical ventilation of the TnI positive patients （52.6%） and the TnI negative patients（23.8%）.The difference（P〈0.05）can also be seen in the time in EICU, the time of TnI positive patients （6.51±1.59）d were higher than that of TnI negative patients（4.96±1.49）d. Conclusion TnI has a special sensitivity and a great significance on diagnosing tiny cardiac injury. The increase of TnI of patients with acute carbon monoxide poisoning indicates the increase of the probabilities of heart cases and mechanical ventilation , it also indicates the lengthening of the time in EICU. TnI can be treated as an index for reference to see the seriousness of the disease and to appraise prognosis.