CK-MB及cTnl在严重创伤后继发性心脏损伤中的临床意义．  

Clinical significance of creatinin kinase-MB and cardiac troponin I in diagnosis of trauma：induced secondary cardiac injury

作　　者：崔真[1] 周宁[1] 

机构地区：[1]北京积水潭医院重症医学科,北京100035

出　　处：《中国急救复苏与灾害医学杂志》2016年第1期32-35,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的评价CK—MB和cTnI对严重创伤后继发性心肌损伤的诊断价值。探讨低血容量性休克对严重创伤后继发性心肌损伤的影响。方法回顾性分析104例严重创伤患者，依据是否并发低血容量性休克分为休克组（56例）与对照组（48例），人院24dx时内检测血清CK—MB及cTnI，观察严重创伤后CK—MB及cTnI的变化情况并进行组间对比。结果两组入选患者在性别比、年龄、ISS评分方面相比差异无统计学意义（P〉0．05）。104例患者中，90例（86．5％）出现了CK—MB升高，其中休克组54例（96．4％），对照组36例（75．0％）。38例（36．5％）出现了cTnI升高，其中休克组34例（60．7％），对照组4例（8．3％）。定量比较显示，休克组及对照组CK—MB中位数（39ng,／mLvs13．8ng／mL）相比，差异有统计学意义（P〈0．001）。休克组及对照组cTnI中位数（O．31ng／mLvs0．01ng／mL）相比，差异有统计学意义（P〈0．001）。cTnI增高的患者中，出现32例（84．2％）心电图异常和13例（34．2％）心脏不良事件。结论继发性心脏损伤是重症创伤后的重要并发症，cTnI增高对其有重要提示意义，其升高程度与心脏不良事件的发生有一定相关性，CK—MB在这类患者中特异较差。低血容量性休克可能是创伤后继发性心肌损伤的重要危险因素。Objective To evaluate the diagnostic values of creatinin kinase-MB （CK-MB） and cardiac troponin I （cTnI） in trauma-induced secondary cardiac injury （TISCI）. Methods 104 patients with severe trauma were divided into 2 groups： shock group （n=56） with hypovolemic shock dianosed according to the deninition of Bulger et al., and control group （n=48） without shock. Peripheral blood samples were collected within 24 h after admission to measure the levels of CK-MB and cTnI by chemoluminescence method. Cardioelectrography was conducted to observe the adverse cardiac events （ACES）. Results There were no significant differences in sex, age, and ISS index between these 2 groups （all P〉0.05）. The median CK-MB level of the shock group was 39 ng/ml, significantly higher than that of the control group （13.8 ng/ml, P 〈0.001）. The median cTnI of the shock group was 0.31 ng/ml, significantly higher than that of the control group （0.01 ng/ml, P 〈0.001）. Conclusion Increased cTnI level is a sensitive index for TISCI and ACES in patients with severe trauma. Hypovolemic shock may be an important risk factor for TISCI.

关 键 词：严重创伤 继发性心脏损伤 低血容量性休克 肌钙蛋白I 

分 类 号：R459.7[医药卫生—急诊医学]