重症监护室脓毒症患儿心肌损伤的临床研究

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(APACHE Ⅱ)评分的关系,分析cTnI、CK-MB、APACHE Ⅱ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APACHE Ⅱ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% vs 2.36%),机械通气发生率(46% vs 21%)和持续时间(7.5 d vs 3.2 d),以及住院时间(11.9 d vs 5.3 d)均显著增高,血清cTnI、CK-MB水平与APACHE Ⅱ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APACHE Ⅱ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APACHE Ⅱ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.

Clinical Study of Myocardial Injury in Critically Ill Children with Sepsis

Objective To explore the incidence of myocardial injury in the critically septic children,and the relationship between elevations of serum cardiac troponin I(cTnI),creatine kinase(CK-MB) and the incidence of myocardial injury and multiple organ dysfunction syndrome(MODS),mortality and acute physiology and chronic health Ⅱ(APACHE Ⅱ) scores.And to evaluate the significance of elevations of serum cTnI,CK-MB and APACHE Ⅱ in critically ill children with sepsis.MethodsThe relationships between levels of cTnI,CK-MB and MODS,myocardial injury,mechanical ventilation,and intensive care unit(ICU) stay were measured by means of retrospective study.Sepsis patients who had been admitted into ICU were studied.The levels of serum cTnI and CK-MB were measured on admission,in 24-72 h and on the 7th day after admission.The APACHE Ⅱ scores were recorded simultaneously.The APACHE Ⅱ scores,ICU mortality and 30 days survival rate between the elevated group and the normal group were compared.ResultsTwo hundred and five(44.7%)of the 459 critically ill children with sepsis had elevated levels of cTnI and/or CK-MB.Patients with myocardial injury were more frequently in need of mechanical ventilation(46% vs 21%),with longer duration of mechanical ventilation(7.5 d vs 3.2 d),higher mortality(26.34% vs 2.36%),and longer ICU stay(11.9 d vs 5.3 d),compared with patients without myocardial injury.The levels of serum cTnI,CK-MB and APACHE Ⅱ scores revealed a positive correlation.The APACHE Ⅱ scores and mortality were higher in elevated group than those in normal group on admission,in 24-72 h and on the 7th day(Pa<0.05).The 30-day survival rate was worse in elevated group than that in normal group(P<0.01).ConclusionsThe incidence of myocardial injury defined by elevated levels of serum cTnI and CK-MB are unexpectedly high and is associated with mortality,MODS incidence,mechanical ventilation,and ICU stay.cTnI,CK-MB,and APACHE Ⅱ scores are predictors for outcome in critically ill children with sepsis.J Appl Clin Pediatr,2011,26(6): 423-426