论文部分内容阅读
目的观察脓毒性休克患者血肌钙蛋白Ⅰ(cardiactroponinⅠ,cTnⅠ)变化规律和对预后的判断价值。方法以2006年1月至2009年11月我院收治的98例成年脓毒性休克患者为研究对象,分为cTnⅠ升高组(38例)和正常组(60例)。采用回顾性病例对照研究,采集患者的一般资料、临床结局、入ICU48h内心肌酶学指标(CK、CK-MB和cTnⅠ)和入ICU时心电图变化。分析cTnⅠ水平与CK、CK-MB、APACHEⅡ评分、SOFA评分、血管活性药物用量指数、机械通气时间、ICU住院时间和总住院时间的相关性及对住院病死率的预测价值。结果 38例患者cTnⅠ水平升高,cTnⅠ水平与CK-MB、APACHEⅡ评分、SOFA评分和血管活性药物用量指数具有相关性(相关系数r分别为0.759、0.624、0.711、0.516)。cTnⅠ正常组与cTnⅠ升高组APACHEⅡ评分、SOFA评分、血管活性药物用量指数和住院病死率差异有统计学意义(P=0.004、0.037、0.015、0.032)。多因素Logistic分析显示cTnⅠ水平升高是预测脓毒性休克住院病死率的独立危险因素(OR=0.613,95%CI=0.301～2.18,P=0.015)。结论 cTnⅠ水平升高可反映脓毒性休克患者心肌受损的程度,可作为脓毒性休克预后监测的一项指标。
Objective To observe the changes of cardiac troponin Ⅰ (cTn Ⅰ) and the prognostic value in patients with septic shock. Methods A total of 98 adult septic shock patients admitted to our hospital from January 2006 to November 2009 were enrolled in this study. The patients were divided into cTn Ⅰ elevated group (n = 38) and normal group (n = 60). A retrospective case-control study was performed to collect the general information of the patients, clinical outcome, electrocardiogram changes during myocardial ICU48h (CK, CK-MB and cTnI) and ICU admission. The correlation between cTn Ⅰ level and CK, CK-MB, APACHEⅡscore, SOFA score, vasoactive drug dosage index, mechanical ventilation time, ICU hospitalization time and total hospitalization time and the predictive value of in-hospital mortality were analyzed. Results 38 cases of patients with elevated cTn Ⅰ level, cTn Ⅰ level and CK-MB, APACHE Ⅱ score, SOFA score and vasoactive drug dosage index has a correlation (correlation coefficient r were 0.759,0.624,0.711,0.516). APACHEⅡscore, SOFA score, vasoactive drug dosage index and hospital mortality in cTnⅠnormal group and cTnⅠlevel group were significantly different (P = 0.004,0.037,0.015,0.032). Multivariate logistic analysis showed that elevated cTnI level was an independent risk factor for predicting hospital mortality in septic shock (OR = 0.613, 95% CI = 0.301-2.18, P = 0.015). Conclusion The elevated cTnI level may reflect the degree of myocardial damage in patients with septic shock and may be used as an indicator of the prognosis of septic shock.