中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
12期
739-742
,共4页
孙中吉%杨朝斌%王辉%李樱
孫中吉%楊朝斌%王輝%李櫻
손중길%양조빈%왕휘%리앵
中毒,一氧化碳%心肌损伤%横纹肌损伤%左旋肉碱
中毒,一氧化碳%心肌損傷%橫紋肌損傷%左鏇肉堿
중독,일양화탄%심기손상%횡문기손상%좌선육감
Carbon monoxide poisoning%Myocardial injury%Striomuscular injury%L-carnitine
目的 观察血清心肌损伤标志物水平与一氧化碳(C0)中毒程度的关系,并评价左旋肉碱的治疗作用.方法 从本院309例急性一氧化碳中毒(ACOP)患者中选择69例入院时血清心肌损伤标志物水平异常增高者,按照入院顺序随机分为对照组34例,观察组35例.在氧疗和对症治疗的基础上,对照组静脉滴注醒脑静20 ml/d；观察组静脉滴注醒脑静20 ml/d+左旋肉碱2 g/d.于治疗24 h、72 h和1周后分别检测碳氧血红蛋白(HbCO)浓度和心肌损伤标志物肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平.分析CO中毒程度(HbCO浓度)与心肌损伤标志物水平异常升高的关系,比较两组患者治疗前后的差异.结果 入院时轻度中毒(HbCO浓度10％～19％)、中度中毒(20％～39％)、重度中毒(≥40％)患者中,心肌损伤标志物水平异常的检出率分别为2.5％(5/204)、46.8％(36/77)、100.0％(28/28),与HbCO浓度具有极显著相关性(x2=170.354 9,P＜0.000 1).对照组和观察组治疗前HbCO[(31.1±17.6)％、(32.3±16.9)％)]、Mb(μg/L:154.2±51.8、165.4±48.6)、CK-MB(μg/L:8.7±3.3、9.6±3.8)、cTnI(μg/L:2.7±1.2、2.8±1.5)比较差异均无统计学意义(均P＞0.05).与对照组比较,观察组治疗24 h、72 h后Mb(24 h:74.0±36.5比97.1±35.8,72 h:40.1±6.8比69.0±11.2)、cTnI水平(24 h:1.9±0.5比2.3±0.7,72 h:1.2±0.3比1.8±0.4)及治疗24 h后CK-MB(10.6±4.1比13.0±3.9)显著降低(P＜0.05或P＜0.01);1周后两组心肌损伤标志物均降至正常水平；治疗过程中HbCO浓度的下降两组间无明显差异.结论 CO中毒后心肌损伤标志物水平异常升高的检出率与HbCO浓度呈正相关,左旋肉碱有减轻CO中毒后心肌损伤和横纹肌损伤的治疗作用.
目的 觀察血清心肌損傷標誌物水平與一氧化碳(C0)中毒程度的關繫,併評價左鏇肉堿的治療作用.方法 從本院309例急性一氧化碳中毒(ACOP)患者中選擇69例入院時血清心肌損傷標誌物水平異常增高者,按照入院順序隨機分為對照組34例,觀察組35例.在氧療和對癥治療的基礎上,對照組靜脈滴註醒腦靜20 ml/d；觀察組靜脈滴註醒腦靜20 ml/d+左鏇肉堿2 g/d.于治療24 h、72 h和1週後分彆檢測碳氧血紅蛋白(HbCO)濃度和心肌損傷標誌物肌紅蛋白(Mb)、肌痠激酶同工酶(CK-MB)、心肌肌鈣蛋白I(cTnI)水平.分析CO中毒程度(HbCO濃度)與心肌損傷標誌物水平異常升高的關繫,比較兩組患者治療前後的差異.結果 入院時輕度中毒(HbCO濃度10％～19％)、中度中毒(20％～39％)、重度中毒(≥40％)患者中,心肌損傷標誌物水平異常的檢齣率分彆為2.5％(5/204)、46.8％(36/77)、100.0％(28/28),與HbCO濃度具有極顯著相關性(x2=170.354 9,P＜0.000 1).對照組和觀察組治療前HbCO[(31.1±17.6)％、(32.3±16.9)％)]、Mb(μg/L:154.2±51.8、165.4±48.6)、CK-MB(μg/L:8.7±3.3、9.6±3.8)、cTnI(μg/L:2.7±1.2、2.8±1.5)比較差異均無統計學意義(均P＞0.05).與對照組比較,觀察組治療24 h、72 h後Mb(24 h:74.0±36.5比97.1±35.8,72 h:40.1±6.8比69.0±11.2)、cTnI水平(24 h:1.9±0.5比2.3±0.7,72 h:1.2±0.3比1.8±0.4)及治療24 h後CK-MB(10.6±4.1比13.0±3.9)顯著降低(P＜0.05或P＜0.01);1週後兩組心肌損傷標誌物均降至正常水平；治療過程中HbCO濃度的下降兩組間無明顯差異.結論 CO中毒後心肌損傷標誌物水平異常升高的檢齣率與HbCO濃度呈正相關,左鏇肉堿有減輕CO中毒後心肌損傷和橫紋肌損傷的治療作用.
목적 관찰혈청심기손상표지물수평여일양화탄(C0)중독정도적관계,병평개좌선육감적치료작용.방법 종본원309례급성일양화탄중독(ACOP)환자중선택69례입원시혈청심기손상표지물수평이상증고자,안조입원순서수궤분위대조조34례,관찰조35례.재양료화대증치료적기출상,대조조정맥적주성뇌정20 ml/d；관찰조정맥적주성뇌정20 ml/d+좌선육감2 g/d.우치료24 h、72 h화1주후분별검측탄양혈홍단백(HbCO)농도화심기손상표지물기홍단백(Mb)、기산격매동공매(CK-MB)、심기기개단백I(cTnI)수평.분석CO중독정도(HbCO농도)여심기손상표지물수평이상승고적관계,비교량조환자치료전후적차이.결과 입원시경도중독(HbCO농도10％～19％)、중도중독(20％～39％)、중도중독(≥40％)환자중,심기손상표지물수평이상적검출솔분별위2.5％(5/204)、46.8％(36/77)、100.0％(28/28),여HbCO농도구유겁현저상관성(x2=170.354 9,P＜0.000 1).대조조화관찰조치료전HbCO[(31.1±17.6)％、(32.3±16.9)％)]、Mb(μg/L:154.2±51.8、165.4±48.6)、CK-MB(μg/L:8.7±3.3、9.6±3.8)、cTnI(μg/L:2.7±1.2、2.8±1.5)비교차이균무통계학의의(균P＞0.05).여대조조비교,관찰조치료24 h、72 h후Mb(24 h:74.0±36.5비97.1±35.8,72 h:40.1±6.8비69.0±11.2)、cTnI수평(24 h:1.9±0.5비2.3±0.7,72 h:1.2±0.3비1.8±0.4)급치료24 h후CK-MB(10.6±4.1비13.0±3.9)현저강저(P＜0.05혹P＜0.01);1주후량조심기손상표지물균강지정상수평；치료과정중HbCO농도적하강량조간무명현차이.결론 CO중독후심기손상표지물수평이상승고적검출솔여HbCO농도정정상관,좌선육감유감경CO중독후심기손상화횡문기손상적치료작용.
Objective To examine the serum level of myocardial injury markers in patients with carbon monoxide(CO)poisoning,the correlation between these markers and the severity of the disease,and the therapeutic effects of L-carnitine administration.Methods 69 patients,chosen from 309 cases of acute carbon monoxide poisoning(ACOP)for abnormally high level of serum myocardial injury markers (myoglobin,Mb; MB isoenzyme of creatine kinase,CK-MB; cardiac troponin-I,cTnI)at the time of admission,were randomly divided into control group(n=34)and observation group(n=35).The patients in control group were given Xingnaojing(20ml/d i.v.drip),and the observation group Xingnaojing (20 ml/d)+L-carnitine(2 g/d i.v.drip),in addition to the conventional oxygen supply and symptom-focused therapy.The plasma concentration of carboxyhemoglobin(HbCO,as index for CO poisoning severity),Mb,CK-MB,and cTnI in these patients were further examined 24 hours,72 hours and 1 week after the treatment,for difference between the two groups,and the correlation between the serum level of HbCO and the myocardial injury markers.Results At the time of admission,the incidence of abnormal findings in myocardial injury markers were 2.5％(5/204),46.8％(36/77)and 100.0％(28/28)in patients with mild(HbCO:10％～19％),moderate(20％～39％)and severe(≥40％)CO poisoning,respectively.The incidence of abnormal findings in injury markers was significantly correlated to the HbCO concentration (x2=170.354 9,P＜0.000 1).Before the treatment,no significant difference was found in any of the indexes[HbCO:(31.1±17.6)％,(32.3±16.9)％,Mb(μg/L):154.2±51.8,165.4±48.6,CK-MB (μg/L):8.7 ± 3.3,9.6± 3.8),and cTnI(μg/L):2.7± 1.2,2.8 ± 1.5,all P＞ 0.05]between the control and observation group.However,it was found in:Mb(24 hours:74.0±36.5 vs.97.1±35.8,72 hours:40.1±6.8 vs.69.0±11.2),cTnI(24hours:1.9±0.5 vs.2.3±0.7,72 hours:1.2±0.3 vs.1.8±0.4)both 24 hours and 72 hours after the treatment,and CK-MB,24 hours after treatment(10.6± 4.1 vs.13.0±3.9)with the values in observation group significantly lower(P＜0.05 or P＜0.01); 1 week after the treatment,the concentration of all the injury markers returned to the normal levels with no significant difference between the two groups.Meanwhile,no significant difference was found between the two groups in HbCO concentration throughout the due-course of the therapy.Conclusions The incidence of abnormal findings in serum myocardial injury markers was positively correlated with HbCO concentration after CO poisoning.L-carnitine may protect the myocardium and striated muscles against injury in patients with CO poisoning.
