大面积烧伤患者发生早期心肌损伤的危险因素及早期心肌损伤对预后的影响  

Risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns

作　　者：陈诺 席毛毛 阮琼芳 褚志刚 张伟 张锦丽 谢卫国 Chen Nuo;Xi Maomao;Ruan Qiongfang;Chu Zhigang;Zhang Wei;Zhang Jinli;Xie Weiguo(Institute of Burns,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430060,China;The Second School of Clinical Medicine of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学同仁医院暨武汉市第三医院烧伤研究所,武汉430060 [2]武汉大学第二临床学院,武汉430060

出　　处：《中华烧伤与创面修复杂志》2023年第5期417-423,共7页Chinese Journal of Burns And Wounds

基　　金：国家自然科学基金面上项目(81772097);武汉市临床医学科研项目(WG19B02);上海王正国创伤医学发展基金会生长因子复兴计划项目(SZYZ-TR-10)。

摘　　要：目的探讨大面积烧伤患者发生早期心肌损伤的危险因素及早期心肌损伤对预后的影响。方法采用回顾性病例系列研究方法。2018年1月—2022年8月,武汉大学同仁医院暨武汉市第三医院收治361例符合入选标准的大面积烧伤患者,其中男231例、女130例,年龄50(36,58)岁,烧伤总面积45%(35%,60%)体表总面积。根据伤后72 h内心肌型肌酸激酶同工酶(CK-MB)最高值,将患者分为早期心肌损伤组(CK-MB≥75 U/L,182例)和非早期心肌损伤组(CK-MB<75 U/L,179例)。收集并分析2组患者性别、年龄、烧伤总面积、伤后入院时间、入院时合并休克情况、入院时合并吸入性损伤情况,伤后72 h内心肌酶谱、血常规、肝肾功能、电解质等主要血液检查指标,治疗结局和病死率。对数据进行χ^(2)检验、独立样本t检验或Mann-Whitney U检验。行多因素logistic回归分析,筛选大面积烧伤患者发生早期心肌损伤的独立危险因素和死亡的独立危险因素。结果2组患者性别、入院时合并休克情况、烧伤总面积、伤后入院时间比较,差异均有统计学意义(χ^(2)值分别为6.40、6.10,Z值分别为5.41、3.03,P<0.05),年龄、入院时合并吸入性损伤情况均相近(P>0.05)。早期心肌损伤组患者伤后72 h内CK-MB、肌酸激酶、乳酸脱氢酶、α-羟丁酸脱氢酶、白细胞计数、中性粒细胞与淋巴细胞比值(NLR)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶、钾、血红蛋白均明显高于非早期心肌损伤组(Z值分别为15.40、6.26、7.59、7.02、2.64、4.53、4.07、6.32、4.12,t=2.34,P<0.05),钙明显低于非早期心肌损伤组(Z=2.72,P<0.05);2组患者其余血液检查指标比较,差异均无统计学意义(P>0.05)。烧伤总面积、伤后入院时间、伤后72 h内NLR和ALT均为大面积烧伤患者发生早期心肌损伤的独立危险因素(比值比分别为1.03、1.07、1.04、1.02,95%置信区间分别为1.02~1.05、1.00~1.11、1.02~1.07、1.00~1.03,P<0.05)Objective To analyze the risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns.Methods A retrospective case series study was conducted.From January 2018 to August 2022,361 patients with extensive burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University&Wuhan Third Hospital,including 231 males and 130 females,aged 50(36,58)years,with total burn area of 45%(35%,60%)total body surface area.According to the highest level of creatine kinase isoenzyme-MB(CK-MB)within 72 h post injury,the patients were divided into early myocardial injury group(CK-MB≥75 U/L,182 patients)and non-early myocardial injury group(CK-MB<75 U/L,179 patients).The following data of patients in the 2 groups were collected and analyzed,including gender,age,total burn area,admission time post injury,combination with shock on admission,combination with inhalation injury on admission;the main blood test indexes such as myocardial enzyme spectrum,blood routine,liver and kidney function,and electrolytes within 72 h post injury;and treatment outcomes and fatality rate.Data were statistically analyzed with chi-square test,independent sample t test,or Mann-Whitney U test.The multivariate logistic regression analysis was conducted to screen the independent risk factors for early myocardial injury and for death in patients with extensive burns.Results There were statistically significant differences in gender,combination with shock on admission,total burn area,and admission time post injury of patients between the two groups(withχ^(2) values of 6.40 and 6.10,Z values of 5.41 and 3.03,respectively,P<0.05).There were no statistically significant differences in age,combination with inhalation injury on admission of patients between the two groups(P>0.05).The CK-MB,creatine kinase,lactate dehydrogenase,α-hydroxybutyrate dehydrogenase,white blood cell count,neutrophil-to-lymphocyte ratio(NLR),alanine aminotransferase(ALT),aspartate aminotransferase,pota

关 键 词：烧伤 危险因素 预后 心肌损伤 

分 类 号：R644[医药卫生—外科学]