Edouard A R, Benoist J F, Cosson C, Mimoz O, Legrand A, Samii K
Service d'Anesthésie-Réanimation, Central Hospitalier de Bicêtre, Le Kremlin Bicêtre, France.
Intensive Care Med. 1998 Jun;24(6):569-73. doi: 10.1007/s001340050617.
To describe the evolution and the diagnostic value of cardiac troponin I (cTnI) and to relate its concentrations with the indicators of injury in trauma patients.
Prospective, observational study of 17 young, previously healthy, mechanically-ventilated patients during the early post-traumatic period in the Surgical ICU of a University Hospital.
Serial measurements of serum cTnI, total creatine kinase activity (CKtot) and its isoenzyme MB (CK-MB) (on admission, 12 h later, then daily for 7 days), clinical data and repeated electrocardiographic (ECG) and transesophageal echocardiographic (TEE) recordings.
Rhabdomyolysis was observed in all the patients with a significant relationship between CK-MB and CKtot. Despite the fact that no patient demonstrated ECG or TEE signs of myocardial contusion, elevated serum levels of cTnI were observed in six patients (35%) without obvious dilutional interference. As compared with the others, these patients exhibited a more frequent arterial hypotension (83% vs 18%, p = 0.035), required greater volume expansion on day 1 (22,000 vs 8,500 ml, p = 0.027) and usually demonstrated early (83% vs 9%, p = 0.005) and late (66% vs 9%, p = 0.028) multiple organ dysfunction syndrome.
Taking into account the high reported sensitivity and specificity of cTnI dosage, the present results suggest cTnI can play a role in the evaluation of indirect myocardial injury following traumatic shock.
描述心肌肌钙蛋白I（cTnI）的演变及其诊断价值，并将其浓度与创伤患者的损伤指标相关联。
对一家大学医院外科重症监护病房17名年轻、既往健康、接受机械通气的患者在创伤后早期进行前瞻性观察研究。
连续测量血清cTnI、总肌酸激酶活性（CKtot）及其同工酶MB（CK-MB）（入院时、12小时后，然后连续7天每天测量）、临床数据以及重复进行心电图（ECG）和经食管超声心动图（TEE）记录。
所有患者均出现横纹肌溶解，CK-MB与CKtot之间存在显著相关性。尽管没有患者表现出心肌挫伤的ECG或TEE迹象，但6名患者（35%）血清cTnI水平升高，且无明显稀释干扰。与其他患者相比，这些患者动脉低血压更为常见（83%对18%，p = 0.035），第1天需要更多的液体复苏（22,000对8,500 ml，p = 0.027），并且通常表现出早期（83%对9%，p = 0.005）和晚期（66%对9%，p = 0.028）多器官功能障碍综合征。
考虑到报道的cTnI检测具有较高的敏感性和特异性，目前的结果表明cTnI可在创伤性休克后间接心肌损伤的评估中发挥作用。
