多发伤患者心脏肌钙蛋白Ⅰ动态变化与创伤评分的关系

Relationship of dynamic changes of myocardial serum troponin Ⅰ in multiple trauma patients to three injury scales

目的 观察多发伤患者心脏肌钙蛋白Ⅰ的动态变化并探讨其与损伤严重度评分(ISS)、急性生理学和长期健康评估 (APACHE)Ⅱ及胸部创伤定量的关系。 方法 将 10 8例多发伤患者 ,根据有无合并胸部创伤分为两组 :合并胸部创伤组 76例 ,无合并胸部创伤组 3 2例 ,均进行ISS、APACHEⅡ和胸部简明损伤定级 (AIS)。定期采集两组患者血样品 ,并用微粒子荧光免疫法检测样本心脏肌钙蛋白Ⅰ (cInⅠ )浓度。 结果 动态监测 10 8例多发伤患者中 ,12例血清cInⅠ浓度时间曲线呈单峰陡降型 ,13例为单峰缓降型 ,6例为双峰型。在一定范围内 ,不论有无合并胸部创伤 ,血清cInⅠ峰值与ISS值呈一定相关性 (r =0 .676,P <0 .0 1) ;对合并有胸部创伤患者分重度胸部创伤组 (AIS≥ 3 )与轻、中度胸部创伤组 (AIS <3 )进一步研究发现 ,两组cInⅠ峰值差异有显著性意义 (P <0 .0 5)。对多发伤患者以APACHEⅡ≥ 15为危重组、APACHEⅡ <15为普通组分组研究显示 ,两组患者血清cInⅠ升高率差异有非常显著性意义 (P <0 .0 1)。进一步比较单峰型血清cInⅠ浓度时间曲线的APACHEⅡ分值与双峰型的APACHEⅡ分值 ,显示差异有非常显著性意义 (P <0 .0 1)。 结论 多发伤患者血清cInⅠ浓度 -时间曲线大致有三种特征 ,即单峰陡降型、单峰缓降型。

Objective To define the relationship of dynamic chang es of cardiac troponin Ⅰ (cTnⅠ) following multiple trauma to injury severity sco re (ISS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and abbre viated injury scale (AIS). Methods Two categories of multip le trauma patients (108 cases) suspected of having cardiac damage were included, ie, patients with blunt chest trauma (n=76) and those without (n=32). AIS in ch est, ISS and APACHEⅡ were performed in all cases. Serum samples from these pati ents were analyzed for quantify the concentration of cTnI by microparticle-enzy me immunoassay (MEIA) at a set interval. Results The concen tration of cTnⅠ showed a single peak and sharp down curve in 12 patients with m ultiple trauma, a single peak and slow down curve in 13 and a double peak curve in six. In patients with or without blunt chest trauma, ISS was related to cTnⅠ peak concentration in some extent ( r =0.676, P <0.01). Multiple trauma pa tients suspected of having cardiac damage were divided into critical group (APAC HEⅡ≥15) and general group (APACHEⅡ<15). There was a significant difference in increase of cTnⅠ in both groups ( P < 0.01) . We also found a very signifi cant difference in APACHEⅡ between patients with single peak cTnⅠ curve and th ose with double peak cTnⅠ curve ( P <0.01). Conclusions There are three types of cTnⅠ concentration-time curves, single peak and sharp down, single peak and slow down, and double peak. In certain range, the peak va lue of serum cTnⅠ is related to ISS value and AIS related to ISS. The patients with double peak cTnⅠ curve are usually under a critical condition with high AP ACHEⅡ and poor prognosis.