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目的探讨重症监护室脓毒症患儿心肌损伤的发生率,心肌肌钙蛋白I(cTnI)及CK-MB水平升高与心肌损伤、多器官功能障碍综合征(MODS)、病死率及与急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分的关系,分析cTnI、CK-MB、APACHEⅡ在评价危重脓毒症患儿预后中的作用。方法回顾性分析459例脓毒症患儿血清cTnI、CK-MB水平与MODS、心肌损伤、机械通气时间、ICU住院时间和病死率的关系。分别测定脓毒症患儿入院时、入院第3天、第7天血清cTnI及CK-MB水平,比较不同时间点酶学升高组和酶学正常组的APACHEⅡ评分、ICU病死率和30 d生存率。结果 459例危重病脓毒症患儿中205例(44.7%)发生心肌损伤[cTnI和(或)CK-MB升高],cTnI、CK-MB升高患儿的病死率远远高于cTnI、CK-MB未升高患儿(26.34%vs2.36%),机械通气发生率(46%vs21%)和持续时间(7.5 dvs3.2 d),以及住院时间(11.9 dvs5.3 d)均显著增高,血清cTnI、CK-MB水平与APACHEⅡ评分之间存在显著正相关。患儿入院时、入院24~72 h和入院第7天,酶学升高组APACHEⅡ评分、ICU病死率均明显高于酶学正常组(Pa<0.05);而30 d生存率低于正常组(P<0.01)。结论血清cTnI、CK-MB水平升高提示危重患儿心肌损伤的发生。血清cTnI、CK-MB在评价危重病患儿预后中发挥重要作用。血清cTnI、CK-MB和APACHEⅡ评分升高的患儿其病死率、MODS发生率、机械通气发生率及住院时间均显著增加。
Objective To investigate the incidence of myocardial injury, the increase of cardiac troponin I (CKT) and CK-MB in myocardial infarction patients with myocardial infarction, multiple organ dysfunction syndrome (MODS), mortality and acute myocardial infarction Physiological and Chronic Health Status Ⅱ (APACHE Ⅱ) score, analyze the role of cTnI, CK-MB, APACHE Ⅱ in evaluating the prognosis of children with severe sepsis. Methods A retrospective analysis of 459 cases of sepsis in children with serum cTnI, CK-MB levels and MODS, myocardial injury, mechanical ventilation, ICU length of stay and mortality in the relationship. Serum levels of cTnI and CK-MB were measured at 3 days and 7 days after admission in children with sepsis. APACHE II score, ICU mortality rate and 30 d Survival rate. Results In 459 critically ill sepsis patients, 205 cases (44.7%) had myocardial injury [cTnI and / or CK-MB elevation]. The mortality rate of cTnI and CK-MB in children was much higher than that of cTnI (26.34% vs 2.36%), the incidence of mechanical ventilation (46% vs 21%) and duration (7.5 days vs 3.2 days), and hospital stay (11.9 days vs 5.3 days) Significantly increased serum cTnI, CK-MB levels and APACHE Ⅱ score between the significant positive correlation. At admission, 24 to 72 hours of admission and 7 days of admission, APACHEⅡscore and ICU mortality rates were significantly higher in patients with elevated enzyme group than those in normal group (P <0.05), while those in 30-day group were lower than those in normal group (P <0.01). Conclusion Serum levels of cTnI and CK-MB are indicative of myocardial injury in critically ill children. Serum cTnI and CK-MB play an important role in evaluating the prognosis of critically ill children. Serum cTnI, CK-MB and APACHE Ⅱ score increased mortality, MODS incidence, incidence of mechanical ventilation and hospitalization were significantly increased.