多发伤患者血清肌红蛋白的动态变化及临床意义

目的 了解多发伤患者血清肌红蛋白(Mb)浓度动态变化的规律及与损伤严重度的关系.方法 检测41例多发伤患者(ISS≥16分)伤后1,3,7,14 d的血清肌红蛋白浓度,同时记录伤后第1天的ISS、GCS、简化急性生理评分Ⅱ(simplified acute physiology score Ⅱ,SAPSⅡ)、体表肌肉软组织受伤面积占全身体表面积的百分比、入院时有无休克及最终转归.根据损伤严重度和最终转归分为ISS≥25分组、ISS＜25分组、生存组和死亡组.分别分析四组血清肌红蛋白浓度的动态变化及组间的差异.分析血清肌红蛋白浓度与ISS、GCS、SAPSⅡ、休克及肌肉软组织受伤面积百分比的相关性.结果 多发伤患者伤后血清肌红蛋白浓度变化:在ISS≥25分组下降速度较ISS＜25分组缓慢且各时相点均高于后者;在死亡组先上升再缓慢下降,第3天达到高峰;而生存组呈持续明显下降,在各时相点均低于前者.血清肌红蛋白浓度在各时相点与SAPSⅡ均呈正相关,与ISS在第7,14天呈正相关,与受伤面积百分比在第1天呈正相关,与休克在第1,3天呈正相关;而与GCS在第3,7,14天呈负相关.结论 多发伤患者血清肌红蛋白浓度的动态变化可以反映病情的严重程度、变化趋势及预后,可作为病情监测的有效指标.

Abstract：

Objective To investigate the dynamic change of serum myoglobin and assess its relation with injury severity in multiple trauma patients. Methods The concentration of serum myoglobin in 41 multiple trauma patients (ISS ≥16 points) was detected at days 1,3,7 and 14 after injury. In the meantime, injury severity score ( ISS), Glasgow coma score ( GCS), simplified acute physiology score Ⅱ( SAPS Ⅱ ), percentage of the injured muscle and soft tissue to entire body, shock on admission and ultimate outcomes were recorded at day 1 after injury. All patients were divided into ISS ≥25 group or ISS ＜ 25 group, survival group or death group based on the injury severity and ultimate outcomes. The dynamic changes of the serum myoglobin were observed and compared between the groups. The correlation of the serum myoglobin concentration with ISS, GCS, SAPS Ⅱ score, shock and the percentage of injured muscle and soft tissue was investigated. Results The serum myoglobin concentration in ISS ≥ 25group was decreased more slowly than that in the ISS ＜ 25 group, with higher concentration of the serum myoglobin concentration in the ISS ≥ 25 group than that in the ISS ＜ 25 group at all time points. The serum myoglobin concentration in the death group was increased first, then slowly declined and reached peak at day 3. While in survival group, the serum myoglobin concentration was continuously decreased, with lower serum myoglobin concentration than that in the death group at all time points. The serum myoglobin concentrations were positively correlated with the SAPS Ⅱ score at all time points, with ISS at days 7 and 14, with the percentage of the injured area at day 1 and with the shock at days 1 and 3, while the serum myoglobin concentration was negatively correlated with GCS at days 3,7 and 14. Conclusions The dynamic changes of the serum myoglobin concentration in multiple trauma patients may reflect the severity,trends and prognosis of the injury, and hence can be used as effective index for monitoring the disease.

Dynamic change of serum myoglobin and its clinical significance in multiple trauma patients

Objective To investigate the dynamic change of serum myoglobin and assess its relation with injury severity in multiple trauma patients. Methods The concentration of serum myoglobin in 41 multiple trauma patients (ISS ≥16 points) was detected at days 1,3,7 and 14 after injury. In the meantime, injury severity score ( ISS), Glasgow coma score ( GCS), simplified acute physiology score Ⅱ( SAPS Ⅱ ), percentage of the injured muscle and soft tissue to entire body, shock on admission and ultimate outcomes were recorded at day 1 after injury. All patients were divided into ISS ≥25 group or ISS ＜ 25 group, survival group or death group based on the injury severity and ultimate outcomes. The dynamic changes of the serum myoglobin were observed and compared between the groups. The correlation of the serum myoglobin concentration with ISS, GCS, SAPS Ⅱ score, shock and the percentage of injured muscle and soft tissue was investigated. Results The serum myoglobin concentration in ISS ≥ 25group was decreased more slowly than that in the ISS ＜ 25 group, with higher concentration of the serum myoglobin concentration in the ISS ≥ 25 group than that in the ISS ＜ 25 group at all time points. The serum myoglobin concentration in the death group was increased first, then slowly declined and reached peak at day 3. While in survival group, the serum myoglobin concentration was continuously decreased, with lower serum myoglobin concentration than that in the death group at all time points. The serum myoglobin concentrations were positively correlated with the SAPS Ⅱ score at all time points, with ISS at days 7 and 14, with the percentage of the injured area at day 1 and with the shock at days 1 and 3, while the serum myoglobin concentration was negatively correlated with GCS at days 3,7 and 14. Conclusions The dynamic changes of the serum myoglobin concentration in multiple trauma patients may reflect the severity,trends and prognosis of the injury, and hence can be used as effective index for monitoring the disease.