感染中毒性和低血容量性休克病人的心肌坏死研究  

Study on myocardial necrosis in patients with septic shock or hypovolemic shock

作　　者：李景荣[1] 李延辉[1] 朱华栋[2] 于学忠[2] 邵孝鉷[2] 

机构地区：[1]北京市房山区第一医院心内科,102400 [2]中国医学科学院中国协和医科大学北京协和医院急诊科

出　　处：《中国急救医学》2001年第6期336-338,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的　研究感染中毒性和低血容量性休克病人的心肌坏死及其特征。方法　 6 4例感染中毒性休克和低血容量休克患者按照休克持续时间分为轻、中、重 3组 ,观察每组患者的心电图、肌钙蛋白Ⅰ、肌红蛋白、肌酸磷酸激酶、肌酸磷酸激酶同工酶MB的动态变化。结果　入院时所有患者均无AMI的心电图表现 ,入院后 2 4h有 45例患者的心电图表现为明显的ST段压低或非特异的ST -T改变 ,休克持续时间较长的患者血清心脏酶学标记物较休克持续时间较短的患者明显升高 ,死亡的患者较存活的患者肌钙蛋白Ⅰ水平高 (分别为 4 4μg/L和 0 71μg/L ,P <0 0 1)。 结论　感染中毒性休克和低血容量性休克病人的心肌坏死很常见 ,但心电图变化不典型 ,休克患者血清肌钙蛋白Ⅰ水平越高 ,预后越差。Objective To study myocardial necrosis in patients with septic shock and hypovolemic shock and to search for signs of cardiac necorsis.Methods Sixty-four patients with septic shock or hypovolemic shock were divided into mild shock group,moderate shock group and severe shock group according to hypotension duration.A standard 12-lead ECG was recorded upon enrollment and at 24h after enrollment.The serum levels of cardiac troponin I(cTnI),myoglobin(Mb),creatine kinase(CK)and creatine kinase MB mass(CK-MB)were measured at 12 h,24 h and 48 h after enrollment.Results At enrollment no signs of AMI on ECG were recognized in any of the patients,distinct ST segment depression and non-specific ST-T changes were observed in 45 patients at 24 h after enrollment.The longer the hypotensive episode was,the greater was the cTnI increase(moderate hypotension:median 1.32 μg/L;quartiles 0.55～3.50 μg/L,severe hypotension:median 8.82 μg/L;quartiles 1.50～19.56 μg/L;P<0.05).Higher levels of cTnI were more frequent in non-survivors than in survivors(4.4 μg/L and 0.71 μg/L,respectively,P<0.01).Conclusions Hypotension may cause myocardial necrosis in patients with septic shock or hypovolemic shock.It is likely that a high number of these myocardial necroses may go unnoticed on the ECG.An unfavorable outcome correlated with higher cTnI values.

关 键 词：感染中毒性 低血容量性休克 心肌坏死 肌钙蛋白Ⅰ 

分 类 号：R605.97[医药卫生—急诊医学]