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目的 研究感染中毒性和低血容量性休克病人的心肌坏死及其特征。方法 6 4例感染中毒性休克和低血容量休克患者按照休克持续时间分为轻、中、重 3组 ,观察每组患者的心电图、肌钙蛋白Ⅰ、肌红蛋白、肌酸磷酸激酶、肌酸磷酸激酶同工酶MB的动态变化。结果 入院时所有患者均无AMI的心电图表现 ,入院后 2 4h有 45例患者的心电图表现为明显的ST段压低或非特异的ST -T改变 ,休克持续时间较长的患者血清心脏酶学标记物较休克持续时间较短的患者明显升高 ,死亡的患者较存活的患者肌钙蛋白Ⅰ水平高 (分别为 4 4μg/L和 0 71μg/L ,P <0 0 1)。 结论 感染中毒性休克和低血容量性休克病人的心肌坏死很常见 ,但心电图变化不典型 ,休克患者血清肌钙蛋白Ⅰ水平越高 ,预后越差。
Objective To study myocardial necrosis and its characteristics in patients with toxic and hypovolemic shock. Methods Sixty-four patients with toxic shock and hypovolemic shock were divided into mild, moderate and severe groups according to the duration of shock. The electrocardiogram, troponin I, myoglobin, creatine phosphokinase, Dynamic changes of acid phosphate kinase isoenzyme MB. Results No electrocardiogram (ECG) of AMI was found in all the patients at admission. The electrocardiogram of 45 patients showed significant ST-segment depression or nonspecific ST-T changes at 24 hours after admission. Serum cardiological markers of patients with longer shock duration Patients with significantly shorter duration of shock were significantly higher in those patients who died than those who survived (44 microg / L and 0 71 microg / L, respectively; P <0.01). Conclusions Myocardial necrosis is common in patients with toxic shock and hypovolemic shock, but the electrocardiogram changes are not typical. The higher the serum level of troponin I in patients with shock, the poorer the prognosis.