CAJ | 학술논문

目的：探讨骨折患者围术期肌钙蛋白升高对短期（30 d）和长期（3年）病死率的预测意义。方法2005年1月－2010年1月，65岁或以上因髋部骨折的患者在入院时均进行登记，在入院时、术前和术后第1、3天完成心电图、肌钙蛋白检测并随访3年。结果285例患者完成研究，其中101例（35．4％）出现肌钙蛋白升高：入院时肌钙蛋白已经升高者31例（30.7％）、术前升高者17例（16．8％）、术后肌钙蛋白升高者53例（52．5％）；153例（53．7％）出现心电图改变，包括65例（22．8％） ST段压低、11例（3．9％） ST段抬高及77例（27．0％） T波倒置。肌钙蛋白升高者其短期和长期病死率均高于正常者（18．8％比3．3％，P＜0.01，61．4％比40.8％，P＜0.01），肌钙蛋白明显升高（肌钙蛋白＞0.15μg／L）者30 d的病死率较轻度升高（肌钙蛋白在0.03～0.15μg／L）者病死率高（21．9％比13．5％，P＜0.01）。肌钙蛋白升高是短期和长期病死率的独立预测因子。除ST段抬高外，缺血性心电图改变对病死率无影响。结论围术期肌钙蛋白升高是短期和长期病死率的强烈预测因子，常规肌钙蛋白检测和及时诊断，有效治疗对这类易损患者有重要临床意义。
목적：탐토골절환자위술기기개단백승고대단기（30 d）화장기（3년）병사솔적예측의의。방법2005년1월－2010년1월，65세혹이상인관부골절적환자재입원시균진행등기，재입원시、술전화술후제1、3천완성심전도、기개단백검측병수방3년。결과285례환자완성연구，기중101례（35．4％）출현기개단백승고：입원시기개단백이경승고자31례（30.7％）、술전승고자17례（16．8％）、술후기개단백승고자53례（52．5％）；153례（53．7％）출현심전도개변，포괄65례（22．8％） ST단압저、11례（3．9％） ST단태고급77례（27．0％） T파도치。기개단백승고자기단기화장기병사솔균고우정상자（18．8％비3．3％，P＜0.01，61．4％비40.8％，P＜0.01），기개단백명현승고（기개단백＞0.15μg／L）자30 d적병사솔교경도승고（기개단백재0.03～0.15μg／L）자병사솔고（21．9％비13．5％，P＜0.01）。기개단백승고시단기화장기병사솔적독립예측인자。제ST단태고외，결혈성심전도개변대병사솔무영향。결론위술기기개단백승고시단기화장기병사솔적강렬예측인자，상규기개단백검측화급시진단，유효치료대저류역손환자유중요림상의의。
Objective To investigate the short-term and long-term prognostic value of perioperative troponin I ( TnI) monito-ring in hip fracture patients.Methods All patients with hip fracture were enrolled on admission from January 2005 to January 2010. Of 285 patients, older than 65 years, serum Troponin I and electrocardiogram ( ECG) was evaluated on admission, before operation, and on first and second postoperative days.Median follow-up time was 3 years (1000 days).Results TnI elevation was detected in 101 patients (35.4%):already elevated on admission in 31 patients (30.7%), before operation in 17 patients (16.8%) and only operated in 53 patients (52.5%).Ischemic ECG changes were detected in 153 patients (53.7%), consisting of ST depression (n=65, 22.8%), ST elevation (n=11, 3.9%), or T-wave inversion (n=77, 27.0%).Patients with TnI elevation had higher short-term and long-term mortality (18.8%vs 3.3%, P<0.01, 61.4%vs 40.8%, P<0.01), mortality of 30 days being higher in pa-tients with major (TnI≥0.15 μg/L) compare with mild (TnI=0.03-0.15 μg/L) TnI elevation (21.9% vs 13.5%, P<0.01). TnI elevation was the independent predictor of short-term mortality.ECG changes other than ST elevation did not affect mortality.Con-clusion Perioperative TnI elevation is a strong predictor of short-term and long-term mortality.Routine TnI detection and earlier diag-nosis together with effective treatment may improve survival of this fragile patient group.