重型/危重型新型冠状病毒肺炎的心脏表现  

Cardiac presentations in severe and critical coronavirus disease 2019

作　　者：童裕维[1] 谢志伟[2] 李粤平 吕明芳[1] 邓西龙[2] 张复春[3] 雷春亮[3] Tong Yuwei;Xie Zhiwei;Li Yueping;Lyu Mingfang;Deng Xilong;Zhang Fuchun;Lei Chunliang(Department of Internal Medicine,the Eighth People's Hospital of Guangzhou,Guangzhou 510000,Guangdong,China;Department of Intensive Care Unit,the Eighth People's Hospital of Guangzhou,Guangzhou 510000,Guangdong,China;Department of Infectious Disease,the Eighth People's Hospital of Guangzhou,Guangzhou 510000,Guangdong,China)

机构地区：[1]广州市第八人民医院内科,广东广州510000 [2]广州市第八人民医院重症监护室,广东广州510000 [3]广州市第八人民医院感染科,广东广州510000

出　　处：《中华危重病急救医学》2021年第2期229-232,共4页Chinese Critical Care Medicine

基　　金：广东省防控新型冠状病毒科技公关应急专项(2020B111105001)。

摘　　要：目的探讨重型/危重型新型冠状病毒肺炎(新冠肺炎)的心脏表现及可能的影响因素。方法采用回顾性研究方法,以2020年1月21日至2月24日广州市第八人民医院收治的重型/危重型新冠肺炎患者为研究对象。根据临床分型将患者分为重型组和危重型组,对比分析两组患者心肌损伤标志物,如乳酸脱氢酶(LDH)、天冬氨酸转氨酶(AST)、肌酸激酶(CK)、心肌肌钙蛋白I(cTnI)、肌红蛋白(MYO)、肌酸激酶同工酶(CK-MB)、B型钠尿肽(BNP)以及心电图变化。结果共入选55例重型/危重型新冠肺炎患者,其中危重型15例,重型40例。重型/危重型患者以男性为主(占61.8%),平均年龄(61.2±13.0)岁,83.6%(46例)有湖北接触史,38.2%(21例)合并高血压。危重型组与重型组基线资料比较差异均无统计学意义。重型/危重型患者心肌损伤标志物均有不同程度升高,以LDH升高患者最多(重型20例,危重型7例),其次是AST(重型16例,危重型5例);重型组与危重型组心肌损伤标志物中仅CK升高患者数差异有统计学意义(例:1比4,P=0.027)。42例进行心电图检查的患者中有39例表现异常,最常见的为非特异性T波改变。治疗前后进行过心电图和心肌损伤标志物检查的15例患者中,有9例氧合指数<100 mmHg(1 mmHg=0.133 kPa),突出的心电图改变为心率较前增快和ST-T段改变。结论心肌损伤标志物和心电图异常对重型/危重型新冠肺炎相关心肌损伤的诊断缺乏特异性,但同时观察两者动态演变更能反映心肌受损情况。Objective To investigate the cardiac presentations and the possible influencing factors of severe and critical coronavirus disease 2019(COVID-19).Methods A retrospective study was conducted.Patients with severe and critical COVID-19 admitted to the Eighth People's Hospital of Guangzhou from January 21st to February 24th 2020 were enrolled.According to the clinical classification,the patients were divided into severe group and critical group.The myocardial injury markers,such as lactate dehydrogenase(LDH),aspartate aminotransferase(AST),creatine kinase(CK),cardiac troponin I(cTnI),myoglobin(MYO),MB isoenzyme of creatine kinase(CK-MB),B-type natriuretic peptide(BNP)and electrocardiogram(ECG)changes were compared between the two groups.Results A total of 55 COVID-19 patients were selected,including 15 critical cases and 40 severe cases.The patients with severe and critical COVID-19 were male-dominated(61.8%),the average age was(61.2±13.0)years old,83.6%(46 cases)of them had contact history of Hubei,38.2%(21 cases)of them were complicated with hypertension.There was no significant difference in baseline data between the critical group and the severe group.Myocardial injury markers of critical and severe COVID-19 patients were increased in different proportion,LDH increased in most patients(20 severe cases and 7 critical cases),followed by AST(16 severe cases and 5 critical cases).There was significant difference in the number of patients with elevated CK between severe group and critical group(cases:1 vs.4,P=0.027).Abnormal ECG was found in 39 of 42 patients with ECG examination.Nonspecific change of T wave was the most common.Before and after treatment,9 of 15 patients with changes of ECG and myocardial injury markers had oxygenation index less than 100 mmHg(1 mmHg=0.133 kPa),and the prominent changes of ECG were heart rate increasing and ST-T change.Conclusions The increase of myocardial injury markers and abnormal ECG were not specific to the myocardial injury of severe and critical COVID-19 patients.At the same

关 键 词：新型冠状病毒肺炎 危重型 重型 心肌损伤标志物 心电图 

分 类 号：R563.1[医药卫生—呼吸系统]