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目的:对重型颅脑损伤患者外伤24 h内检测心肌肌钙蛋白I(cardiac troponin I,c Tn I)并进行有关的临床观察和分析,探讨其与患者病情发展及预后的关系。方法:采用前瞻性研究方法对新入院的重型颅脑损伤患者外伤后24 h内检测血c Tn I,解读重型颅脑损伤患者c Tn I异常升高的发生率,格拉斯哥昏迷评分(GCS)高低与c Tn I的关系,c Tn I升高与颅脑损伤患者心血管事件发生率和死亡率的关系,c Tn I预测重型颅脑外伤患者死亡的统计学意义。结果:1重型颅脑损伤患者外伤后24 h内c Tn I异常升高率达25.6%(45/176);3例(7.7%)达0.04 ng/m L,其余正常;2 c Tn I异常升高患者更易发生心血管事件:心电图异常,超声心动图异常,N-末端B型利钠肽原(NT-pro BNP)>300 ng/L;3住院期间共死亡47例(26.7%),主要死亡原因为心跳呼吸骤停、多器官功能衰竭和心功能衰竭;4如c Tn I>0.4 ng/m L,预测敏感度为36.2%、特异度达97.7%、阳性预测值达85.0%且假阳性情况很少;如c Tn I测定值超过1.0 ng/m L,则患者全部预后不良。结论:重型颅脑损伤患者外伤24 h内血c Tn I异常升高者其颅脑损伤程度更重并容易发生心血管事件和死亡,可作为损伤严重度分层及死亡预测指标;该型患者c Tn I异常可能主要出现于外伤早期阶段,其异常升高的机制不清,可能与其他疾病如蛛网膜出血不同。
OBJECTIVE: To detect cardiac troponin I (cTn I) in patients with severe craniocerebral injury within 24 hours after trauma and to investigate the relationship between cTn I and the progression of disease and prognosis. Methods: A prospective study was conducted to detect the level of cTn I in patients with severe traumatic brain injury within 24 hours after trauma. The incidence of abnormal cTnI in patients with severe craniocerebral injury was analyzed. The GCS level was analyzed. And cTnI, cTnI increased in patients with craniocerebral injury and cardiovascular events and mortality, cTnI prediction of severe craniocerebral injury in patients with statistical significance. Results: The abnormal increase rate of c Tn I was 25.6% (45/176) within 24 hours after trauma in 1 patient with severe craniocerebral injury, 3 (7.7%) was 0.04 ng / m L, and the others were normal. The abnormality of 2 c Tn I Patients with elevated disease were more likely to have cardiovascular events: electrocardiogram abnormalities, echocardiographic abnormalities,> 300 ng / L N-terminal pro-BNP; 3 47 (26.7%) died during hospitalization, The main causes of death were heartbeat and respiratory arrest, multiple organ failure and heart failure. 4 The predictive sensitivity was 36.2%, the specificity 97.7% and the positive predictive value 85.0% for cTn I> 0.4 ng / m L False positives are rare; if the cTn I value exceeds 1.0 ng / m L, the patient has a poor overall prognosis. Conclusion: Patients with severe craniocerebral injury have abnormal increase of cTnI within 24 hours after trauma. Those patients with severe craniocerebral injury are more likely to have cardiovascular events and death, which can be used as a predictor of stratification and death. c Tn I abnormalities may occur mainly in the early stages of trauma, the mechanism of abnormal increase unclear, may be different from other diseases such as arachnoid hemorrhage.