脓毒症休克患者心肌损伤程度及预后判断的研究

目的 探讨心肌肌钙蛋白Ⅰ（cTnI）、脑钠尿肽（BNP）、血乳酸、急性生理和慢性健康评估（APACHE）Ⅱ评分在脓毒症休克患者中判断心肌损伤程度及预后的价值.方法 确诊脓毒症休克患者61例,入院后即刻,治疗后6,24h检测血乳酸、BNP、cTnI水平,并进行APACHEⅡ评分,观察存活组和死亡组上述指标差异.结果 61例患者中35例存活（存活组）,26例死亡（死亡组）.死亡组入院后即刻BNP、cTnI、血乳酸、APACHEⅡ评分均明显高于存活组,差异有统计学意义（P＜0.05）.死亡组治疗后6h上述指标与入院后即刻比较差异无统计学意义（P＞0.05）,治疗后24 h上述指标显著高于入院后即刻,差异有统计学意义（P＜0.05）.存活组治疗后6,24h上述指标均较入院后即刻明显降低,且治疗后24 h上述指标均较治疗后6h也明显降低BNP：（478.1±95.3） ng/L比（1025.2±263.3） ng/L;cTnI：（0.9±0.1） μg/L比（2.5±0.4）μg/L;血乳酸：（2.4±0.3） mmol/L比（5.4±2.1） mmol/L; APACHEⅡ评分：（11.4±1.8）分比（15.6±2.9）分],差异均有统计学意义（P＜0.05）.结论 BNP、cTnI、血乳酸、APACHEⅡ评分可反映脓毒症休克患者心肌损伤的严重程度,预测患者预后.

Clinical study on evaluation of severity of sepsis shock patients with myocardium injury

Objective To explore the value of cardiac troponin Ⅰ （cTnI）,brain natriuretic peptide （BNP）,blood lactate and acute physiology and chronic health evaluation （APACHE） Ⅱ score which used to evaluate the severity of sepsis shock patients with myocardium injury.Methods Data of 61 patients with sepsis shock were collected,and cTnI,BNP,blood lactate were monitored and APACHE Ⅱ score were scored at admission,6,24 h after treatment.All of these indicators were compared between death group and survival group.Results In 61 patients,35 cases of them were lived （survival group）,26 cases of them were died （death group）.The cTnI,BNP,blood lactate and APACHE Ⅱ score at admission in death group was significantly higher than that in survival group （P＜ 0.05）.In death group all of these indicators there was no significantly difference between admission and 6 h after treatment （P ＞0.05）;24 h after treatment was significantly higher than that 6 h after treatment （P ＜ 0.05）.In survival group 6,24 h after treatment was significantly lower than that at admission,24 h after treatment was significantly lower than that 6 h after treatment BNP：（478.1 ± 95.3）ng/L vs.（1 025.2 ± 263.3） ng/L,cTnI：（0.9 ± 0.1） μ g/L vs.（2.5 ± 0.4） μ g/L,blood lactate：（2.4 ± 0.3） mmol/L vs.（5.4 ± 2.1） mmol/L,APACHE Ⅱ score：（11.4 ± 1.8） scores vs.（15.6 ± 2.9） scores] （P ＜ 0.05）.Conclusion BNP,cTnI,blood lactate and APACHE Ⅱ score may be used to evaluate the severity of sepsis shock patients with myocardium injury and predict outcome of the patients.