重型颅脑损伤患者血清肌钙蛋白I及心肌酶谱变化的意义

目的探讨重型颅脑损伤患者血清肌钙蛋白I(cTnI)及心肌酶谱(ME)的变化及其对患者预后的影响。方法重型颅脑损伤患者32例分为GCS3分组(n=6)、GCS4~5分组(n=11)和GCS6~8分组(n=15)。测定伤后1、6、12、24h以及第2、3、4、5、6、7d血清cTnI和ME的变化,同时动态观察心电图的变化。结果32例患者中cTnI异常26例,其峰值出现在伤后6h,5d后恢复正常;血清cTnI和ME含量GCS3分组>GCS4~5分组>GCS6~8组(P<0.05或P<0.01)。GCS评分越低,cTnI和ME含量越高,病情越严重。32例中死亡4例(12.5%),存活28例(87.5%),死亡患者的cTnI和ME含量均明显高于存活者(P<0.01)。心电图表现异常者30例,主要表现为ST-T改变,大多出现在伤后3~5d。结论血清cTnI、ME可作为判断重型颅脑损伤患者早期预后的参考指标。

The clinical significance of cardiac troponin I and myocardium enzymogram in severe traumatic brain injury patients

Objective To investigate the prognosis and influence of cardiac troponin I(cTnI)and myocardium enzymogram(ME)in severe traumatic brain injury patients.Method Thirty two consecutive patients with severe traumatic brain injury were divided into 3 score groups,GCS 3 group(6 cases),GCS 4-5 score group(11 cases)and GCS 6-8 group(15 cases).Concentration of cTnI in serum was measured in 1hr,6hr,12hr and 24hr after trauma.cTnI and myocardium zymogram were measured every 24hr after trauma for a week.ECG was also recorded simultaneously.Result The level of cTnI was abnormal in 26 of 32 cases.The maximal level appeared after 6 hours,and recovered to normal after 5 days.The level of TnI and ME were different among three groups significantly(P<0.05 or P<0.01).The lower of GCS score,the higher of cTnI and ME level.Furthermore,cTnI and ME level were higher in dead patients(4 cases)than in that of survivors(28 cases,P<0.01).There were 30 patients presented with abnormal ECG,the most appeared abnormalities were ST-T changes in 3-5 days after trauma.Conclusion cTnI and ME could be reference index to evaluate the prognosis of severe traumatic brain injury patients.