Müllner M, Oschatz E, Sterz F, Pirich C, Exner M, Schörkhuber W, Laggner A N, Hirschl M M
Department of Emergency Medicine, Vienna General Hospital, University of Vienna, Medical School, Austria.
Resuscitation. 1998 Aug;38(2):99-105. doi: 10.1016/s0300-9572(98)00087-2.
This study sought to determine the influence of resuscitative procedures, such as chest compressions and external defibrillation, on the release of creatine kinase (CK)-MB and cardiac troponin T (cTnT).
In 87 patients with out-of-hospital cardiac arrest and successful cardiopulmonary resuscitation (CPR), the initial ECG rhythm, the duration of cardiac arrest and CPR, and the number of defibrillations were assessed on arrival in the hospital. The serum CK-MB and cTnT were measured 12 h after the event. We also assessed whether the patient developed cardiogenic shock within 12 h, and if the patient had acute myocardial infarction (AMI), which was confirmed or eliminated by of typical ECG findings, thallium-201 myocardial scintigraphy, or autopsy within the hospital stay. A backward stepwise linear regression model was applied to assess the association between the markers of myocardial injury (CK-MB and cTnT) and the above clinical variables.
CK-MB concentrations were independently associated with the presence of AMI [B 68.5 (SE 28.5, P = 0.018)], the duration of CPR (as a measure of trauma to the chest by means of chest compressions) [B 2.07 (SE 1.01, P = 0.045)] and cardiogenic shock [B 52.3 (SE 23.4, P = 0.03)]. The remaining clinical variables listed were excluded by the model. Cardiac troponin T concentrations were only associated with the presence of AMI [B 4.86 (SE 1.34, P = 0.0005)]. There was a non-significant association between increasing serum cTnT concentrations and the presence of cardiogenic shock [B 2.51 (SE 1.46, P = 0.09)]. The remaining clinical variables were excluded by the model.
The release of CK-MB appears to be influenced by the duration of resuscitation and the presence of cardiogenic shock. This has to be considered when interpreting serum CK-MB concentrations after CPR. The release of cTnT seems to be only associated with acute myocardial infarction, but not with the duration of chest compressions, or with the number of defibrillations administered.
本研究旨在确定复苏措施，如胸外按压和体外除颤，对肌酸激酶（CK）-MB和心肌肌钙蛋白T（cTnT）释放的影响。
对87例院外心脏骤停且心肺复苏（CPR）成功的患者，在入院时评估其初始心电图节律、心脏骤停和CPR持续时间以及除颤次数。事件发生12小时后测定血清CK-MB和cTnT。我们还评估了患者在12小时内是否发生心源性休克，以及患者是否患有急性心肌梗死（AMI），在住院期间通过典型心电图表现、铊-201心肌闪烁显像或尸检来确诊或排除。应用向后逐步线性回归模型评估心肌损伤标志物（CK-MB和cTnT）与上述临床变量之间的关联。
CK-MB浓度与AMI的存在独立相关[B 68.5（标准误28.5，P = 0.018）]、CPR持续时间（作为通过胸外按压对胸部创伤的指标）[B 2.07（标准误1.01，P = 0.045）]和心源性休克[B 52.3（标准误23.4，P = 0.03）]。列出的其余临床变量被模型排除。心肌肌钙蛋白T浓度仅与AMI的存在相关[B 4.86（标准误1.34，P = 0.0005）]。血清cTnT浓度升高与心源性休克的存在之间存在无显著意义的关联[B 2.51（标准误1.46，P = 0.09）]。其余临床变量被模型排除。
CK-MB的释放似乎受复苏持续时间和心源性休克存在的影响。在解释CPR后血清CK-MB浓度时必须考虑这一点。cTnT的释放似乎仅与急性心肌梗死相关，而与胸外按压持续时间或给予的除颤次数无关。
