急性一氧化碳中毒性心脏病预后影响因素分析  

Analysis of prognostic factors of acute carbon monoxide toxic heart disease

作　　者：曹双清 高珣[1] 刘倩[1] 刘永建[1] 肖青勉[1] 朱保月[1] 李伟[1] 王维展[1] Cao Shuangqing;Gao Xun;Liu qian;Liu Yongjian;Xiao Qingmian;Zhu Baoyue;Li Wei;Wang Weizhan(Department of Emergency Medicine,Harrison International Peace Hospital,Hebei Medical University,Hengshui,Hebei 053000,China)

机构地区：[1]河北医科大学哈励逊国际和平医院急救医学部,河北省衡水053000

出　　处：《中华急诊医学杂志》2020年第8期1093-1098,共6页Chinese Journal of Emergency Medicine

基　　金：2018年河北省医学科学研究重点支持项目(20181600)。

摘　　要：目的探讨临床相关因素对急性一氧化碳中毒性心脏病患者近期预后的影响。方法选择2017年10月至2019年12月入住本院急救医学部的急性一氧化碳中毒(ACOP)患者中符合中毒性心脏病诊断的患者92例,记录患者从发现中毒到就诊时间、昏迷时间、住院时间、是否行气管插管、是否入住ICU病房、入院时急性生理与慢性健康状况评分(APACHEⅡ评分);行心电图检查,测量并计算入院时、d 2、d 3、出院时经心率校正后的QT离散度(QTcd)时长;收集入院时、d 2、d 3、出院时的血清肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)水平。根据《职业性急性化学物中毒性心脏病诊断标准》将患者分为:轻度心脏病组45例,中度心脏病组35例和重度心脏病组12例。各组定量资料用均数±标准差(Mean±SD)表示,采用单因素方差分析检验,组间两两比较采用LSD-t检验,计数资料比较采用χ^检验,相关性分析采用Spearman相关法及二元Logistic回归分析。结果重度组的APACHEⅡ评分、昏迷时间及住院时间均高于轻中度两组,是否早期行气管插管保护气道及入住ICU病房的比例低于轻中度两组,差异均具有统计学意义(P<0.05)。各组cTnI、QTcd在入院即出现增高,与健康对照组比较差异有统计学意义(P<0.05),重度组cTnI、QTcd与轻中度组在入院时比较均具差异有统计学意义(P<0.05)。而重度组的CK-MB在入院第2-3天才与轻中度组表现出统计学差异(P<0.05);入院当天血清cTnI与APACHEⅡ评分的相关性为(r1=1.000,r2=0.458),入院当天QTcd间期与APACHEⅡ相关性为(r1=1.000,r2=0.765),均呈正相关,具差异有统计学意义(P<0.01)。结论ACOP患者需尽早入院治疗,对于缺氧严重、没有气道保护能力的患者应及早建立人工气道,并在中毒早期入住监护病房稳定病情,注意观察患者QTcd、血清cTnI、CK-MB等指标变化,及时发现心脏损伤并加以保护。Objective To investigate the effect of clinical factors on the short-term prognosis of patients with acute carbon monoxide toxic heart disease.Methods From October 2017 to December 2019,92 patients with acute carbon monoxide poisoning(ACOP)and toxic heart disease admitted to the Department of Emergency of our hospital were enrolled in this study.The duration from poisoning to hospital admission,duration of coma,length of hospital stay,endotracheal intubation or not,admission to ICU ward or not,acute physiology and chronic health evaluation(APACHEⅡscore)at admission were recorded.The heart rate-corrected QT dispersion(QTcd)calculated based on electrocardiography results,as well as levels of serum trocalin I(cTnI)and creatine kinase isoenzyme(CK-MB)were recorded at admission,day 2,day 3,and hospital discharge.According to the diagnostic criteria of occupational cute toxic cardiopathy caused by chemicals,the patients were divided into three groups:45 cases in the mild heart disease group(mild group),35 cases in the moderate heart disease group(moderate group)and 12 cases in the severe heart disease group(severe group).The variables data of each group were presented as Mean±SD,and analyzed using one-way anova test.LSD-t test was used for pairwise comparison between the groups.Attributes data were compared usingχ^2 comparisontest,and correlations were analyzed using Spearman correlation method and binary logistic regression analysis.Results APACHE II score was significantly higher,and the durations of coma,and hospitalization time of severe heart disease group were significantly higher longer in the severe heart disease group than those ofin the mild and moderate groups,and the proportions of patients with early tracheal intubation to protect airway and admission in ICU ward were both significantly lower in the severe heart disease group than those ofin the mild and moderate moderate groups(all P<0.05).The levels of CTnI and QTcd in each group increased immediately after admission,which was statistically different

关 键 词：一氧化碳中毒(ACOP) 急性 中毒性心脏病 人工气道 心率校正后的QT离散度(QTcd) 肌钙蛋白I(cTnI) 肌酸激酶同工酶(CK-MB) 预后 

分 类 号：R541.9[医药卫生—心血管疾病]