中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2015年
5期
527-530
,共4页
目的 探讨脓毒症患者血清降钙素原(PCT)与心肌肌钙蛋白I(cTnI)水平的相关性.方法 将湖北省中西医结合医院重症医学科2013年6月至2015年2月收治的126例脓毒症患者按病情严重程度分为脓毒症组、严重脓毒症组及脓毒性休克组,每组42例,监测3组患者72 h内乳酸(Lac)和中心静脉血氧饱和度(ScvO2)的变化,比较3组患者的病死率及入院后24 h内的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血清PCT及cTnI水平,探讨血清PCT与cTnI水平和APACHEⅡ评分的相关性.结果 脓毒症、严重脓毒症、脓毒性休克患者随着病情严重程度的增加,Lac(mmol/L)均逐渐增加(治疗前:5.82±2.42、7.97±3.76、10.30±2.82,治疗后6 h:3.63±1.54、5.08±1.98、7.50±1.35,治疗后12 h:2.70±1.55、4.13±1.96、6.23±1.16,治疗后24 h:2.58±1.35、3.95±2.44、5.25±1.13,治疗后48 h:2.15±1.82、3.86±2.36、4.12±1.72,治疗后72 h:1.83±1.04、3.78±1.84、3.74±0.87),ScvO2均逐渐降低(治疗前:0.556±0.102、0.502±0.095、0.402±0.092,治疗后6 h:0.627±0.062、0.557±0.083、0.504±0.075,治疗后12 h:0.658±0.076、0.601±0.083、0.595±0.072,治疗后24 h:0.676±0.059、0.625±0.084、0.603±0.050,治疗后48 h:0.704±0.049、0.656±0.066、0.615±0.035、治疗后72 h:0.755±0.053、0.707±0.066、0.629±0.048),Lac越高,ScvO2越低,3组间比较差异均有统计学意义(均P<0.01).脓毒症、严重脓毒症、脓毒性休克3组脓毒症患者的病死率〔11.9%(5/42)、21.4%(9/42)、38.1%(16/42)〕、血清PCT(μg/L:治疗前为5.21±2.92、17.20±4.81、40.71±5.22,治疗后4 d为2.51±1.52、10.72±3.83、46.45±4.25)、cTnI水平(μg/L:治疗前为5.31±0.82、9.50±0.31、15.12±3.15,治疗后4 d为1.16±0.62、5.35±0.53、9.24±1.25)、APACHEⅡ评分(分:治疗前为10.41±3.72、20.15±5.14、35.17±4.58,治疗后4 d为7.25±2.22、14.15±4.16、28.12±3.13)亦随脓毒症严重程度的增加而增加.相关性分析表明,血清PCT水平与cTnI及APACHEⅡ评分有显著正相关性(r值分别为0.922,0.921,均P<0.01).结论 脓毒症患者极易引发心肌损伤,且病情越严重,损伤越明显.
目的 探討膿毒癥患者血清降鈣素原(PCT)與心肌肌鈣蛋白I(cTnI)水平的相關性.方法 將湖北省中西醫結閤醫院重癥醫學科2013年6月至2015年2月收治的126例膿毒癥患者按病情嚴重程度分為膿毒癥組、嚴重膿毒癥組及膿毒性休剋組,每組42例,鑑測3組患者72 h內乳痠(Lac)和中心靜脈血氧飽和度(ScvO2)的變化,比較3組患者的病死率及入院後24 h內的急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分、血清PCT及cTnI水平,探討血清PCT與cTnI水平和APACHEⅡ評分的相關性.結果 膿毒癥、嚴重膿毒癥、膿毒性休剋患者隨著病情嚴重程度的增加,Lac(mmol/L)均逐漸增加(治療前:5.82±2.42、7.97±3.76、10.30±2.82,治療後6 h:3.63±1.54、5.08±1.98、7.50±1.35,治療後12 h:2.70±1.55、4.13±1.96、6.23±1.16,治療後24 h:2.58±1.35、3.95±2.44、5.25±1.13,治療後48 h:2.15±1.82、3.86±2.36、4.12±1.72,治療後72 h:1.83±1.04、3.78±1.84、3.74±0.87),ScvO2均逐漸降低(治療前:0.556±0.102、0.502±0.095、0.402±0.092,治療後6 h:0.627±0.062、0.557±0.083、0.504±0.075,治療後12 h:0.658±0.076、0.601±0.083、0.595±0.072,治療後24 h:0.676±0.059、0.625±0.084、0.603±0.050,治療後48 h:0.704±0.049、0.656±0.066、0.615±0.035、治療後72 h:0.755±0.053、0.707±0.066、0.629±0.048),Lac越高,ScvO2越低,3組間比較差異均有統計學意義(均P<0.01).膿毒癥、嚴重膿毒癥、膿毒性休剋3組膿毒癥患者的病死率〔11.9%(5/42)、21.4%(9/42)、38.1%(16/42)〕、血清PCT(μg/L:治療前為5.21±2.92、17.20±4.81、40.71±5.22,治療後4 d為2.51±1.52、10.72±3.83、46.45±4.25)、cTnI水平(μg/L:治療前為5.31±0.82、9.50±0.31、15.12±3.15,治療後4 d為1.16±0.62、5.35±0.53、9.24±1.25)、APACHEⅡ評分(分:治療前為10.41±3.72、20.15±5.14、35.17±4.58,治療後4 d為7.25±2.22、14.15±4.16、28.12±3.13)亦隨膿毒癥嚴重程度的增加而增加.相關性分析錶明,血清PCT水平與cTnI及APACHEⅡ評分有顯著正相關性(r值分彆為0.922,0.921,均P<0.01).結論 膿毒癥患者極易引髮心肌損傷,且病情越嚴重,損傷越明顯.
목적 탐토농독증환자혈청강개소원(PCT)여심기기개단백I(cTnI)수평적상관성.방법 장호북성중서의결합의원중증의학과2013년6월지2015년2월수치적126례농독증환자안병정엄중정도분위농독증조、엄중농독증조급농독성휴극조,매조42례,감측3조환자72 h내유산(Lac)화중심정맥혈양포화도(ScvO2)적변화,비교3조환자적병사솔급입원후24 h내적급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분、혈청PCT급cTnI수평,탐토혈청PCT여cTnI수평화APACHEⅡ평분적상관성.결과 농독증、엄중농독증、농독성휴극환자수착병정엄중정도적증가,Lac(mmol/L)균축점증가(치료전:5.82±2.42、7.97±3.76、10.30±2.82,치료후6 h:3.63±1.54、5.08±1.98、7.50±1.35,치료후12 h:2.70±1.55、4.13±1.96、6.23±1.16,치료후24 h:2.58±1.35、3.95±2.44、5.25±1.13,치료후48 h:2.15±1.82、3.86±2.36、4.12±1.72,치료후72 h:1.83±1.04、3.78±1.84、3.74±0.87),ScvO2균축점강저(치료전:0.556±0.102、0.502±0.095、0.402±0.092,치료후6 h:0.627±0.062、0.557±0.083、0.504±0.075,치료후12 h:0.658±0.076、0.601±0.083、0.595±0.072,치료후24 h:0.676±0.059、0.625±0.084、0.603±0.050,치료후48 h:0.704±0.049、0.656±0.066、0.615±0.035、치료후72 h:0.755±0.053、0.707±0.066、0.629±0.048),Lac월고,ScvO2월저,3조간비교차이균유통계학의의(균P<0.01).농독증、엄중농독증、농독성휴극3조농독증환자적병사솔〔11.9%(5/42)、21.4%(9/42)、38.1%(16/42)〕、혈청PCT(μg/L:치료전위5.21±2.92、17.20±4.81、40.71±5.22,치료후4 d위2.51±1.52、10.72±3.83、46.45±4.25)、cTnI수평(μg/L:치료전위5.31±0.82、9.50±0.31、15.12±3.15,치료후4 d위1.16±0.62、5.35±0.53、9.24±1.25)、APACHEⅡ평분(분:치료전위10.41±3.72、20.15±5.14、35.17±4.58,치료후4 d위7.25±2.22、14.15±4.16、28.12±3.13)역수농독증엄중정도적증가이증가.상관성분석표명,혈청PCT수평여cTnI급APACHEⅡ평분유현저정상관성(r치분별위0.922,0.921,균P<0.01).결론 농독증환자겁역인발심기손상,차병정월엄중,손상월명현.
Objective To investigate the relationship between the levels of serum procalcitonin (PCT) and cardiac troponin I (cTnI) in patients with sepsis.Methods According to the severity of the disease, 126 patients with sepsis in the Department of Critical Care Medicine of Hubei Provincial Hospital of Integrated Chinese and Western Medicine from June 2013 to February 2015 were divided into three groups: sepsis, severe sepsis and septic shock groups, 42 cases in each group. The changes of lactate (Lac) and central venous oxygen saturation (ScvO2) were monitored in the three groups within 72 hours after admission, the mortality and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score within 24 hours after admission, the levels of serum PCT and cTnI were compared among the three groups, and the correlations between serum PCT, cTnI levels and APACHE Ⅱ score were analyzed.Results Along with the increase of patients' severity in the three groups, the levels of Lac (mmol/L) were gradually increased (prior treatment: 5.82±2.42, 7.97±3.76, 10.30±2.82; 6 hours after treatment: 3.63±1.54, 5.08±1.98, 7.50±1.35; 12 hours after treatment: 2.70±1.55, 4.13±1.96, 6.23±1.16; 24 hours after treatment: 2.58±1.35, 3.95±2.44, 5.25±1.13; 48 hours after treatment: 2.15±1.82, 3.86±2.36, 4.12±1.72; 72 hours after treatment: 1.83±1.04, 3.78±1.84, 3.74±0.87), while the levels of ScvO2 were gradually reduced (prior treatment: 0.556±0.102, 0.502±0.095, 0.402±0.092; 6 hours after treatment: 0.627±0.062, 0.557±0.083, 0.504±0.075; 12 hours after treatment: 0.658±0.076, 0.601±0.083, 0.595±0.072; 24 hours after treatment: 0.676±0.059, 0.625±0.084, 0.603±0.050; 48 hours after treatment: 0.704±0.049, 0.656±0.066, 0.615±0.035; 72 hours after treatment: 0.755±0.053, 0.707±0.066, 0.629±0.048). The higher the Lac, the lower the ScvO2, and the differences among the three groups were of statistical significance (allP < 0.01). The mortalities of patients in the septic, severe septic and septic shock groups were as follows: 11.9% (5/42), 21.4% (9/42), 38.1% (16/42); serum PCT (μg/L): prior treatment: 5.21±2.92, 17.20±4.81, 40.71±5.22; 4 days after treatment: 2.51±1.52, 10.72±3.83, 46.45±4.25; the levels of cTnI (μg/L): prior treatment: 5.31±0.82, 9.50±0.31, 15.12±3.15; 4 days after treatment: 1.16±0.62, 5.35±0.53, 9.24±1.25; APACHE Ⅱ score: prior treatment: 10.41±3.72, 20.15±5.14, 35.17±4.58; 4 days after treatment: 7.25±2.22, 14.15±4.16, 28.12±3.13. Their levels were also increased along with the increase of the septic severity. The correlation analyses showed that the serum levels of PCT was significantly positively correlated with cTnI and APACHE Ⅱ score (r value was respectively 0.922, 0.921, bothP < 0.01).Conclusion Myocardial damage often easily occurs in patients with sepsis, and the more serious the illness, the more prominent the injury.
