急性有机磷农药中毒患者的抢救和护理体会

目的：探讨急性有机磷农药中毒的抢救与护理，提高抢救成功率。方法：回顾性调查分析68例急性有机磷农药中毒患者的抢救护理措施。结果：68例患者中1例因中毒反跳致呼吸衰竭而死亡，其余67例均治愈出院。结论：急性有机磷农药中毒患者具有起病急、病情变化快、病情重、死亡率高等特点，对患者争分夺秒的抢救、仔细观察病情变化及细心护理是提高患者抢救成功率的关键。     

急性有机磷农药中毒血小板与T淋巴细胞动态变化分析

目的 了解急性有机磷农药中毒后患者血小板与T淋巴细胞动态变化情况以指导临床诊断治疗。方法 对来我院就诊的有机磷农药中毒患者分时段抽取静脉血检测生理、生化指标及免疫功能指标,并与对照组比较。结果中毒后T淋巴细胞亚群明显下降,血小板参数异常较对照组有明显差异。结论 急性有机磷农药中毒后患者细胞免疫功能受损,易合并感染。血小板各参数变化对预后不具有重要影响,但可了解中毒程度、了解病情、指导治疗。     

血清淀粉酶在急性有机磷农药中毒患者病情评估中的意义

目的：探讨急性有机磷农药中毒患者血清淀粉酶监测对中毒病人病情评估及临床治疗的意义。方法：116例急性有机磷农药中毒患者根据血清淀粉酶水平将患者分为三组：正常淀粉酶组（A,n=78）、中度增高淀粉酶组（B,n=25）和高淀粉酶组（C,n=13）,对比分析三组病人的白细胞升高率,低血压、呼吸衰竭、消化道出血和肺部感染发生率,治愈率及病死率。结果：116例急性有机磷农药中毒患者38例血清淀粉酶升高,高淀粉酶血症的发生率为32.8%。A、B、C三组并发症（白细胞升高、低血压、消化道出血、肺部感染、呼吸衰竭）发生率呈递增态势;A组死亡率为1.3%,B组死亡率为12.0%,C组死亡率为53.8%。结论：血清淀粉酶水平与急性有机磷农药中毒患者病情危重程度、并发症发生率及预后呈平行关系。在急性有机磷农药中毒救治时应重视对血清淀粉酶的监测,以及时发现和治疗危重病例,提高治愈率,改善预后。     

C反应蛋白在有机磷中毒中的应用

目的：探讨有机磷农药中毒患者血清C反应蛋白(CRP)水平的变化。方法：采用比浊法检测有机磷农药中毒患者血清C反应蛋白含量，采用试纸法测定有机磷农药中毒患者血清胆碱酯酶(ChE)。结果：治疗前有机磷农药中毒患者的血清C反应蛋白含量均有升高，血清胆碱酯酶均有降低，治疗后患者血清C反应蛋白浓度降至正常，血清胆碱酯酶上升至正常。结论：血清C反应蛋白和胆碱酯酶的定期测定比单独测定ChE对有机磷农药中毒病情的判断和疗效的临床价值更大。     

急性有机磷农药中毒患者血清C-反应蛋白的变化及意义

目的 探讨急性有机磷农药中毒患者血清Ｃ－反应蛋白（ＣＲＰ）的变化及意义。方法 采用速率散射比浊法检测５８例急性有机磷农药中毒患者和３０例正常对照,并对其中２５例患者作了动态观察。结果 急性有机磷农药中毒患者血清ＣＲＰ高于正常对照组（Ｐ〈０．０５）;中毒后血清ＣＲＰ开始升高,中毒后第３日达高峰,至中毒后第１２日逐渐恢复至正常水平。结论 血清ＣＲＰ可作为急性有机磷农药中毒患者机体组织细胞损伤的一项指标     

急性有机磷农药中毒患者体液免疫功能的变化及意义

目的：探讨急性有机磷农药中毒患者体液免疫功能的变化及意义。方法：采用速率散射比浊法检测４５例急性有机磷农药中毒患者及３０例正常人血清ＩｇＧ、ＩｇＡ、ＩｇＭ、Ｃ３、Ｃ４水平，并对其中２５例患者作了动态观测。结果：急性有机磷农药中毒患者血清ＩｇＡ高于正常对照组（Ｐ＜０．００１）；中毒后ＩｇＡ开始升高，中毒第３日和第７日均明显高于正常对照组（Ｐ＜０．０５和Ｐ＜０．００１）；ＩｇＧ、ＩｇＭ、Ｃ３、Ｃ４与正常对照组比较均无显著性差异（Ｐ均＞０．０５）。结论：急性有机磷农药中毒患者粘膜局部免疫功能增强，并提示胆碱能神经功能亢进     

急性有机磷农药中毒反跳的防治

在临床上常遇到有机磷农药中毒者，经积极抢救治疗后，部分患者在症状缓解的恢复期，突然出现病情危急变化．甚至死亡，这种现象称为有机磷中毒的反跳。急性有机磷农药中毒有两个死亡高峰，中毒后24h之内为第1高峰；     

中重度急性有机磷农药中毒肾脏损害临床分析

目的 :探讨中重度急性有机磷中毒肾脏损害患者的肾功能变化情况及血透治疗的重要性。方法 :对5 9例中重度急性有机磷农药中毒患者的临床资料进行回顾总结 ,分别对其尿素氮 (BUN)和肌酐 (Cr)作分析。结果 :BUN及Cr的变化和患者中毒程度呈正相关关系 ,中毒程度越深 ,BUN及Cr升高越多 ,反之越少。结论 :急救中重度有机磷农药中毒患者 ,早期对肾功能的变化作出及时监测 ,尽可能早期行血液透析治疗 ,避免出现急性肾功能衰竭 ,对患者心、肺及肝功能的保护有重要作用 ,对病理的转归有积极意义。     

38例急性有机磷农药中毒血清酶学改变及临床意义

目的：探讨血清酶在急性有机磷农药中毒中的变化及其意义。方法：采用速率法测定３８例急性有机磷农药中毒患者和２５例正常人血清肌酸磷酸激酶（ＣＰＫ）、乳酸脱氢酶（ＬＤＨ）、天冬氨酸转氨酶（ＡＳＴ）、碱性磷酸酶（ＡＫＰ）、γ谷氨酰转肽酶（γＧＴ）的浓度。结果：３８例急性有机磷农药中毒患者的ＣＰＫ、ＬＤＨ和ＡＳＴ较对照组均有极显著升高（Ｐ均＜０．００１）。结论：急性有机磷农药中毒时血清ＣＰＫ、ＬＤＨ和ＡＳＴ升高越显著，提示中毒程度越重，其预后不良。     

测定有机磷农药中毒患者血清肌酸磷酸激酶与血胆碱酯酶对判断中毒程度的比较

探讨有机磷农药中毒患者血清肌酸磷酸激酶（ＣＰＫ）及血胆碱酯酶（ＣｈＥ）与中毒程度的关系，从细胞学指标方面了解患者的病情变化，以便更好地估计患者的预后。１９９６年６月～１９９８年５月，我院对１５１例有机磷农药中毒患者测定了血清ＣＰＫ和血ＣｈＥ，并与患者...     

Evaluation of a New Assay for Cardiac Troponin I vs Creatine Kinase-MB for the Diagnosis of Acute Myocardial Infarction

Objective : To compare a new assay for cardiac troponin I (cTn-I) with an assay for creatine kinase-MB (CK-MB) for the diagnosis of acute myocardial infarction (AMI).
Methods : A prospective cross-sectional study of patients presenting with symptoms consistent with cardiac ischemia was performed at a university teaching hospital. Serum sampling for cTn-I and CK-MB was performed at 0, 1, 3, 8, and 16 hours after presentation. Normal values were defined as CK-MB ≤ 7 ng/mL and a relative index ≤ 2%, cTn-I ≤ 1.4 ng/mL. Final diagnosis was made using World Health Organization criteria, including standard enzyme sampling. Consecutive patients with AMI were compared with a randomly selected subset of patients without AMI to determine the sensitivity and specificity of the cTn-I and CK-MB assays for AMI, stratified by time from symptom onset. The ability of the biochemical cardiac markers obtained within 6 hours of symptom onset to predict later complications or need for interventions was assessed using odds ratios (ORs).
Results : Thirty-five patients who had AMI were compared with 136 patients who did not have AMI. The sensitivities and specificities of the cTn-I and CK-MB assays, stratified by time from symptom onset, were: Patients who had elevations in either CK-MB or cTn-I within 6 hours of symptom onset were at increased risk for cardiovascular complications and/or interventions (CK-MB, OR 5.8; cTn-I, OR 6.3).
Conclusion : cTn-I was as sensitive and specific for AMI as was CK-MB in ED patients who presented within 24 hours of symptom onset. However, cTn-I was more sensitive in patients who presented ≥ 24 hours after symptom onset. Elevations of either marker within 6 hours of symptom onset predict an increased risk of complications and/or need for interventions.     

Heart fatty acid binding protein in the rapid evaluation of myocardial damage following valve replacement surgery

BACKGROUND: Myocardial damage occurs following valve replacement surgery. We estimated the value of heart fatty acid binding protein (H-FABP) in these patients. METHODS: Sixty elected patients were enrolled and distributed into single (group A) and double (group B) valve replacement groups. The clinical data were outlined and blood samples were collected perioperatively for determination of plasma levels of H-FABP, cardiac troponin-I (cTn-I), and CK-MB in both groups. RESULTS: 56 patients completed the study and no significant difference of clinical data was observed except CPB time and ACC time between groups. H-FABP level elevated quickly after reperfusion and peaked significantly earlier than cTn-I and CK-MB, it also declined rapidly but did not return to baseline at 24 h after reperfusion. Three markers' levels were all higher in group B than in group A after reperfusion with significant differences at their peaks and thereafter. Patients with postoperative complications had significantly higher H-FABP levels than usual. H-FABP peak level associated well with the length of CPB and ACC as well as with other 2 markers' peak levels in both groups. CONCLUSION: Compared with cTn-I and CK-MB, H-FABP is an earlier and potentially useful marker in the rapid evaluation of myocardial damage following valve replacement surgery with CPB.     

The Prognostic Significance of Troponin I and Troponin T

Abstract. Objectives : To determine and compare the prognostic abilities of early, single-sample measurements of cardiac troponin I (cTn-I), cardiac troponin T (cTn-T), creatine kinase-MB (CK-MB) among ED patients with possible myocardial ischemia. Methods : Prospective collection of clinical and serologic data using an identity-unlinked technique from patients with possible myocardial ischemia at 2 urban EDs. Outcome data concerning the occurrence of adverse events (AEs) during the 14 days after enrollment were used to calculate and compare the relative risks (RRs) and predictive values (with 95% confidence intervals) of the 3 markers for predicting AEs. Results : Among the 401 study patients, 105 AEs occurred in 67 patients. cTn-I, cTn-T, and CK-MB were all significantly predictive of AEs, with RRs of 3.87 (2.39, 6.26), 3.03 (1.92, 4.79), and 6.45 (4.74, 8.77), respectively. For prediction of AEs, sensitivity for each of the 3 markers was low (cTn-I = 15.38, cTn-T = 24.62, CK-MB = 15.38), while specificity was high (cTn-I = 97.62, cTn-T = 93.15, CK-MB = 99.70). No significant difference in predictive ability was found between cTn-I and cTn-T. However, a positive CK-MB result was a stronger predictor of AEs than either cTn-I (p = 0.01) or cTn-T (p = 0.001). Conclusions : No significant difference in predictive abilities was found between cTn-I and cTn-T. However, routine testing for both CK-MB and either of the troponins may optimize early identification of high-risk patients so they may be targeted for a higher level of care and consideration of more aggressive therapies.     

血清超敏C反应蛋白及肌钙蛋白Ⅰ在急性胸痛患者急诊科危险分层中的价值

目的:探讨联合检测血清超敏C反应蛋白(hs-CRP)及肌钙蛋白Ⅰ(cTn-Ⅰ)对急性冠脉综合征(ACS)早期诊断的临床价值.方法:64例急性胸痛患者分别在来诊后0～2小时、2～4小时、4～6小时测定hs-CRP和cTn-Ⅰ水平,并完善心电图、冠脉造影或冠脉CTA以确诊病因.结果:64例急性胸痛患者最终确诊ACS 36例,ACS组hs-CRP检测值在0-2小时即升高,且随时间延长逐步上升,在0～2小时、2～4小时及4～6小时点其检测值均较非ACS组明显升高(P＜0.05);而cTn-Ⅰ检测值在0～2小时组ACS患者与非ACS组无明显差异(P＞0.05),在2～4小时及4～6小时ACS患者较非ACS组明显升高(P＜0.05).结论:联合检测急性胸痛患者的hs-CRP和cTn-Ⅰ对ACS的早期诊断有重要价值,而hs-CRP比cTn-Ⅰ能更早地起到提示作用.     

Release kinetics of serum cardiac troponin i in ischemic myocardial injury

Objectives: The study was undertaken to evaluate the release kinetics of cardiac troponin I (c-cTn-I) in ischemic myocardial injury.

Design and Methods: The reference range for cTn-I was established by determination of cTn-I in sera and plasma obtained from 622 healthy volunteers (Group 1). cTn-I was compared to: (a) Creatine kinase (CK) MB mass and myoglobin in 12 patients with severe skeletal muscle damage (Group 2); (b) CK-MB activity in 48 patients with myocardial infarction (MI) receiving intravenous thrombolysis (Group 3) (in this group, an additional 43 patients with MI were analyzed separately to characterize cTn-I patterns in thrombolyzed and nonthrombolyzed populations); and in 44 patients with unstable angina (Group 4).

Results: In Groups 1 and 2, no positive results (0.1 μg/L) were obtained. In Group 3, the time-courses of cTn-I were mostly monophasic in form. A pathologic increase occurred earlier in cTn-I than in CK-MB activity (p = 0.0002); the period with increased cTn-I was longer (p = 0.001), the overall sensitivity of cTn-I (93.9%) was higher than that of CK-MB activity (p = 0.00001). cTn-I was more sensitive at admission (p = 0.0004). In additional patients, the cTn-I peak occurred and cTn-I disappeared significantly later in nonthrombolyzed than in the thrombolyzed group. In Group 4, positive tests results were detected in 45% of patients for cTn-I, 16% for CK-MB activity, and 32% for CK-MB mass.

Conclusions: The cTn-I assay appears to be ideally suited for the detection of ischemic myocardial injury in complex clinical situations because of its high specificity; cTn-I indicates myocardial tissue damage in patients with unstable angina and is superior to CK-MB activity and mass in this respect.     

81例冠心病患者血清胱抑素C检测分析

目的探讨冠心病患者血清胱抑素(CysC)水平变化与冠心病的相关性。方法选取81例经冠状动脉造影确诊的冠心病患者,分为隐匿型冠心病、心绞痛、急性心肌梗死、心肌梗死(简称心梗)恢复期4个组作为病例组,35例健康体检者作为对照组,同时测CysC及心肌钙蛋白I(cTn-I)的水平并分析两者的相关性。结果隐匿型冠心病组及心绞痛组CysC水平[分别为(1.71±0.37)mg/L及(1.65±0.21)mg/L]升高,与cTn-I水平呈正相关;急性心肌梗死组及心梗恢复期组CysC水平[分别为(0.47±0.23)mg/L及(0.51±0.17)mg/L]降低,与cTn-I水平呈负相关。结论血清胱抑素C水平可以作为监测及诊断冠心病有价值的参考指标。     

急性有机磷农药中毒病人的心肌酶谱变化及临床意义

目的 探讨急性有机磷农药中毒(AOPI)病人心肌酶变化规律。方法 对217例AOPI病人心肌酶(AST、LDH、α-HBDH、CK、CK-MB)进行连续监测,并观察病人心脏功能改变。结果 AOPI病人心肌酶均有不同程度升高,且与中毒程度呈正相关;心肌酶随病情改善呈恢复趋势。结论 心肌酶水平对AOPI病人具有预后作用,极度升高者,病情严重,预后不良。对重症病人应加强心脏临护,以防心原性猝死发生。     

Early Diagnostic Efficiency of Cardiac Troponin I and Troponin T for Acute Myocardial Infarction

Objective : To compare the early diagnostic efficiency of the cardiac troponin I (cTn-I) level with that of the cardiac troponin T (cTn-T) level, as well as the creatine kinase (CK), CK-MB, and myoglobin levels, for acute myocardial infarction (AMI) in patients without an initially diagnostic ECG presenting to the ED within 24 hours of the onset of their symptoms. Methods : A prospective, observational, cohort study was performed involving chest pain patients admitted to a large urban community hospital. Participants were consecutive consenting ED chest pain patients ≥30 years of age. Exclusions included duration of symptoms >24 hours, inability to complete data collection, receipt of CPR, and ST-segment elevation on the initial ECG. Measurements included levels of cTn-I, cTn-T, CK, CK-MB, and myoglobin at the time of presentation and 1, 2, 6, and 12–24 hours after presentation as well as presenting ECG and clinical follow-up. Confirmation of the diagnosis of AMI was based on World Health Organization criteria. Results : Of the 177 patients included in the study, 27 (15%) were diagnosed as having AMIs. The sensitivities of all 5 biochemical markers for AMI were poor at the time of ED presentation (3.7–33.3%) but rose significantly over the study period. The sensitivity of cTn-T was significantly better than that of cTn-I over the initial 2 hours, but both markers' sensitivities were low (<60%) during this time frame. The cTn-I was significantly more specific for AMI than was the cTn-T, but not significantly better than CK-MB or myoglobin. Likelihood ratio analysis showed that the biochemical markers with the highest positive likelihood ratios for AMI during the first 2 hours following ED presentation were myoglobin and CK-MB. From 6 through 24 hours, the positive likelihood ratios for cTn-I, CK-MB, and myoglobin were superior to those of CK and cTn-T. Conclusions : cTn-I, CK-MB, and myoglobin are significantly more specific for AMI than are CK and cTn-T. Myoglobin is the biochemical marker having the highest combination of sensitivity, specificity, and negative predictive value for AMI within 2 hours of ED presentation. Neither cTn-I nor cTn-T offers significant advantages over myoglobin and CK-MB in the early (≤2 hours) initial screening for AMI. The cardiac troponins are of benefit in identifying AMI ≤6 hours after presentation.     

Time-course of cardiac troponin I release from isolated perfused rat hearts during hypoxia/reoxygenation and ischemia/reperfusion.

The study was designed to determine the time-course of cardiac troponin I (cTn-I) release in isolated and Langendorff-perfused rat hearts during hypoxia and reoxygenation (H/Reox), and after various durations of total ischemia and subsequent reperfusion (I/R). For this purpose, in H/Reox, cTn-I was measured with the conventional Access immunoassay (ng/ml) and a new immunoassay which operates at pg/ml, and compared with creatine kinase (CK), lactate dehydrogenase (LD) and cardiac troponin T (cTn-T). In I/R, cTn-I was compared with CK and LD. The anti-Tn-I mAbs used in cTn-I assays cross-react with cTn-I of the rat. A clear difference between time-courses and concentration levels of cTn-I in I/R and H/Reox models was found. In I/R, maximum release of cTn-I, CK and LD similarly occurred within minutes following reperfusion; however cTn-I did not return to baseline values. cTn-I levels were not linked to the duration of ischemia. In I/R, we were only able to detect small cTn-I concentrations. In H/Reox experiments, cTn-I, CK and LD increased time-dependently. We found higher cTn-I maximal peak levels detected with the Access immunoassay than with the new assay (median, 0.346 ng/ml per min/g dry wt vs 132 pg/ml per min/g dry wt). cTn-T maximal concentrations were lower than maximal cTn-I levels (median, 0.117 ng/ml per min/g dry wt). Time-courses of cTn-I release were roughly similar with both assays in the H/Reox model (r = 0.90). These data indicate that the cTn-I time-course is related to experimental model (I/R or H/Reox), but also likely depends on the sensitivity of cTn-I assays in such experimental conditions.     

急性有机磷农药中毒患者血液白细胞和C—反应蛋白水平的变化及 …

目的 探讨急性有机磷农药中毒患者血液白细胞（ＷＢＣ）,中性粒细胞（Ｎ）和Ｃ－反应蛋白（ＣＲＰ）的变化及其临床意义。方法 根据患者入院时中毒的程度设轻度中毒组,中度中毒组,重度中毒组和健康对照组,急性有机磷农药中毒患者在入院的第１日,３日,７日抽静脉血检测,结果 入院第１日,中度中毒组和重度中毒组血液ＷＢＣ,Ｎ,ＣＲＰ水平均显著高于健康对照组（Ｐ〈０．０５和Ｐ〈０．０１）;第３日,第７日中度中毒组的