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重症监护室脓毒症患儿心肌损伤的临床研究
引用本文:黄娇甜,祝益民,卢秀兰. 重症监护室脓毒症患儿心肌损伤的临床研究[J]. 实用儿科临床杂志, 2011, 26(6): 423-426
作者姓名:黄娇甜  祝益民  卢秀兰
作者单位:湖南省儿童医院,重症监护室2科,长沙,410007
摘    要: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.

关 键 词:危重病  脓毒症  心肌损伤  儿童

Clinical Study of Myocardial Injury in Critically Ill Children with Sepsis
HUANG Jiao-tian , ZHU Yi-min , LU Xiu-lan. Clinical Study of Myocardial Injury in Critically Ill Children with Sepsis[J]. Journal of Applied Clinical Pediatrics, 2011, 26(6): 423-426
Authors:HUANG Jiao-tian    ZHU Yi-min    LU Xiu-lan
Affiliation:(Department of Intensive Care Unit 2,Hunan Children′s Hospital,Changsha 410007,Hunan Province,China)
Abstract: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
Keywords:critical illness  sepsis  myocardial injury  child  
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