急性失代偿性心力衰竭患者血清肌钙蛋白T水平检测的价值(1)
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[摘要] 目的：研究肌钙蛋白T的水平变化在急性失代偿性心力衰竭患者预后的价值。方法：选取急诊重症监护室收治的68例急性失代偿性心力衰竭患者，按照cTnT的水平分为cTnT阳性组(27例)和cTnT阴性组(41例)。观察两组患者室性期前收缩发生率、APACHEⅡ评分、在ICU入住时间、住院时间、住院病死率、随访出院后6个月内再入院率及6个月死亡率。结果：两组治疗期间利尿剂、扩血管药物使用、多巴胺和(或)多巴酚丁胺的使用和两组患者6个月随访期间死亡率比较差异无统计学意义(P>0.05)。入院时APACHEⅡ评分、在ICU入住时间、住院时间、住院病死率及出院后6个月内再入院率比较均显示差异有统计学意义(P<0.05)。结论：肌钙蛋白T水平是与治疗无关的危险因素之一。伴有肌钙蛋白T升高的急性失代偿性心力衰竭患者有较高的室性期前收缩发生率、较长的住院时间、短期预后差，监测cTnT水平对急性失代偿性心力衰竭患者的病情评估和短期预后有重要作用。
[关键词] 肌钙蛋白T；急性失代偿性心力衰竭；APACHEⅡ评分；预后
[中图分类号] R541.6 [文献标识码]A[文章编号]1674-4721(2011)03(c)-020-02
Value of cardiac T in the monitoring of acute decompensated heart failure
SONG Xuexin, FAN Shifen, HAN Wei, JIA Wulan, RE Xidan
Department of Emergency, the People’s Hospital of Karamay City, Xinjiang Uyghur Autonomous Region, Karamay 834000, China
[Abstract] Objective: To evaluate the value of cardial T(cTnT) in the monitoring of acute decompensated heart failure. Methods: A total of 68 consecutive acute decompensated heart failure to emergency intensive care unit. All the patients were divided into two groups according to the levels of cTnT: positive group (n=27) and negative group (n=41). Clinical laboratory parameters and the outcome were compared between two groups. Results: There were no significant differences in use of the diuretic, use of the vasodilator, use of the dopamine and (or) dobutamine and mrtality over the 6-month follow up between two groups(P>0.05); there were higher APACHEⅡscores, longer ICU stays, hospital mortality and again into hospital in 6-month in the elevated cTnT group than those in the normal cTnT group (P<0.05). Conclusion: The level of troponin T is one of the risk factor of acute decompensated heart failure. Their days of stay in hospital is longer and prognosis is poor. The detection of cTnT is valuable in evaluating the severity of disease and the clinical prognosis for the treatment of these patients.
[Key words] Cardiac troponin(cTnT); Heart failure; APACHEⅡscores; Prognosis
急性失代性心力衰竭患者是急诊救治目前较多的危重病种之一，随着我国老龄化的进程，此比率呈上升趋势[1]。血清肌钙蛋白T(cardiac troponin T，cTnT)是心肌损害最敏感和特异的标志物,已广泛地应用于急性冠脉综合征的临床诊断中。本研究分析急性失代偿性心力衰竭患者的血清肌钙蛋白T水平，并观测其半年内住院率及病死率，旨在分析其间的关系，为预测预后及不良事件的发生提供途径。
1资料与方法
1.1一般资料
随机观察2009年1~12月在本院急诊科治疗的慢性充血性心力衰竭急性失代偿期患者68例。按2007年我国心脏病学会修订的关于CHF的诊断标准。排除肾功能不全患者及急性冠脉综合征患者。按照cTnT的水平分为cTnT阳性组(27例)和cTnT阴性组(41例)。
1.2方法
68例患者入院后即采血，采用罗氏公司cobase-411全自动生化仪测定血清肌钙蛋白T(cTnT)、肝肾功能、血清电解质、动脉血气分析及急性生理和慢性健康状态评分Ⅱ(APACHEⅡ)等的测定，cTnT>0.4 μg/L为阳性，记录并监测心电图变化 ......
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