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目的探讨危重病患者隐匿性心肌损伤的发生率以及肌钙蛋白Ⅰ(TnⅠ)和APACHEⅡ评分系统在评价危重病患者预后中的作用。方法通过检测2002年10月至2005年6月首都医科大学附属北京朝阳医院急诊重症监护室利用回顾性双盲单中心研究方法分析159例危重病患者血清TnⅠ的质量浓度与APACHEⅡ评分、心肌损伤、机械通气时间、ICU住院时间和病死率发生的关系。结果在159例危重病患者中有34例(21.4%)患者存在TnⅠ的升高,但34例患者中只有9例(26.5%)诊断为心肌梗死,另25例未发现明显的心肌损伤。TnⅠ升高患者的病死率远远高于TnⅠ未升高的患者(41.2%对16.0%);机械通气的发生率(58.8%对23.2%)和持续时间(7.9d对3.1d)也明显增加;ICU的住院时间也显著延长(10.8d对4.3d);心肌TnⅠ和A-PACHEⅡ评分之间存在明显的相关性。心肌TnⅠ增高的患者,APACHEⅡ评分也相应的增高。结论TnⅠ的升高表明危重病患者中并发心肌损伤和功能失调的发生率较高。心肌TnⅠ和APACHEⅡ评分都可以成为危重病患者病死率和存活率发生的独立的预测因子,在评价危重病患者的预后中也发挥重要作用。特别TnⅠ和A-PACHEⅡ评分升高患者的病死率、心肌损伤、机械通气的发生率、ICU住院时间等方面都明显增加。
Objective To investigate the incidence of occult myocardial injury in critically ill patients and the role of troponin Ⅰ (TnⅠ) and APACHEⅡscore systems in evaluating the prognosis of critically ill patients. Methods A retrospective double-blind single-center study was conducted in the emergency intensive care unit of Beijing Chaoyang Hospital, Capital Medical University from October 2002 to June 2005 to analyze the relationship between the serum TnⅠ concentration and APACHEⅡ score, myocardial injury, Mechanical ventilation time, ICU hospitalization time and the incidence of mortality. Results Of the 159 critically ill patients, 34 (21.4%) had elevated TnI, but only 9 (26.5%) of 34 patients were diagnosed with MI and the other 25 patients did not show significant myocardial damage. The mortality of patients with elevated TnI was significantly higher than that of patients without elevated TnI (41.2% vs. 16.0%); the incidence of mechanical ventilation (58.8% vs 23.2%) and duration (7.9d vs. 3.1d) ; ICU hospital stay was also significantly prolonged (10.8d to 4.3d); myocardial Tn Ⅰ and A-PACHE Ⅱ score between the significant correlation. In patients with elevated myocardial TnI, APACHE II scores also increased accordingly. Conclusions The elevated TnI indicates that the incidence of myocardial injury and dysfunction in critically ill patients is high. Myocardial Tn I and APACHE II scores can be independent predictors of mortality and survival in critically ill patients and play an important role in evaluating the prognosis of critically ill patients. In particular, patients with elevated TnI and A-PACHEII scores increased mortality, myocardial damage, the incidence of mechanical ventilation, ICU hospitalization and so on.