肌钙蛋白I在急诊心房颤动和心房扑动患者检测情况分析

Troponin I utilization in patients presenting with atrial fibrillation/flutter to the emergency department:retrospective chart review

目的:回顾性分析心肌标志物肌钙蛋白I(Troponin I,TnI)在急诊科心房颤动和心房扑动(房颤/房扑)患者的检测情况。方法:收集2010年6月至2011年6月,就诊于北京安贞医院急诊科2 190例房颤/房扑患者病例,随机抽取了500例患者的资料进行回顾性分析,分析内容包括肌钙蛋白I检测次数,TnI阳性率和确诊为急性冠状动脉综合征(ACS)的概率。结果:患者至少有1次TnI检测的为86.8%(434/500),其中TnI阳性率为15.7%,诊断为ACS者的概率为5.1%。至少2次检测的患者为41.8%(209/500),其中TnI阳性率为26.8%(56/209),诊断为ACS的占9.6%。结论:在急诊科,房颤/房扑患者有很高的TnI检测率,而急诊患者确诊为ACS仅约5%,提示急诊内科医师需综合评估房颤/房扑患者临床状况后再进行TnI检测,避免临床资源不必要的浪费。

Objective： To investigate the use of cardiac markers in the investigation and management of atrial fibrillation/flutter （Af/AF） in the emergency department. Methods： From June 2010 to June 2011, 2 190 patients with Af/AF presenting to the emergency department of Anzhen Hospital were enrolled in the ret- rospective study. Outcome measures included the rates of troponins ordered by emergency doctors, number of positive troponins, and those with positive troponins treated as acute coronary syndrome （ACS） by observation ward. Results： Five hundred charts were reviewed. 86. 8% （434/500）of the patients had at least one troponin ordered,15.7% had positive results, and 5.1% were treated for ACS. 41.8% （209/500）of the patients were kept for two or more sets of troponins ; of those, 26. 8% （56/209） had positive troponins, and 9. 6% were trea- ted for ACS by observation ward. Conclusion： Troponin tests are ordered in a high percentage of patients with Af/AF presenting to emergency departments. Five percent of our total patient cohort was diagnosed as having ACS by observation ward. Further prospective studies are required to identify those patients who should be test- ed for troponin and be treated for acute coronary syndrome.