脓毒症儿童心肌损伤及保护策略研究
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摘要
目的探讨临床脓毒症儿童心肌损伤情况及心肌保护治疗的方法与疗效。方法采用化学发光法测定脓毒症、严重脓毒症患儿血清肌钙蛋白I(c Tn I)值,将两组c Tn I值升高(> 0. 1 ug/L)合并心肌损伤病例再各自随机分成观察组与对照组,常规治疗基础上,分别给予磷酸肌酸钠与1、6-二磷酸果糖营养心肌治疗,于治疗7天及14天后复查c Tn I值,评估疗效。结果脓毒症与严重脓毒症患儿心肌损伤发生率分别为11. 41%、65. 45%,差异具有统计学意义(P <0. 05)。结论脓毒症尤其是严重脓毒症儿童心肌损伤发生率高,c Tn I值0. 64可作为筛查严重脓毒症诊断界点;严重脓毒症心肌保护治疗推荐使用磷酸肌酸钠。
Objective To explore clinical myocardial injury of children with sepsis,and the method and efficacy of myocardial protection treatment. Methods Measure cardiac troponin I( c Tn I) values of children with sepsis and severe sepsis by means of chemoluminescence,and myocardial injury patients of the two groups with high c Tn I values( > 0. 1 ug/L) were divided randomly into an observation group and a control group separately. On the basis of conventional treatment,treat the observation group and the control group with Creatine Phosphate Sodium and 1,6-FDP myocardial nutrition respectively. Measure the c Tn I values again 7 days and 14 days after the treatment,so as to assess the efficacy. Results The incidence of myocardial injury on children with sepsis and severe sepsis is respectively 11. 41%and 65. 45%. The difference is statistically significant( P < 0. 05). Conclusions The incidence of myocardial injury on children with sepsis,especially with severe sepsis,is high; The c Tn I value 0. 64 can be used as a cut-off point for screening severe sepsis; and Creatine Phosphate Sodium is recommended for myocardial protection treatment on children with severe sepsis.
Objective To explore clinical myocardial injury of children with sepsis,and the method and efficacy of myocardial protection treatment. Methods Measure cardiac troponin I( c Tn I) values of children with sepsis and severe sepsis by means of chemoluminescence,and myocardial injury patients of the two groups with high c Tn I values( > 0. 1 ug/L) were divided randomly into an observation group and a control group separately. On the basis of conventional treatment,treat the observation group and the control group with Creatine Phosphate Sodium and 1,6-FDP myocardial nutrition respectively. Measure the c Tn I values again 7 days and 14 days after the treatment,so as to assess the efficacy. Results The incidence of myocardial injury on children with sepsis and severe sepsis is respectively 11. 41%and 65. 45%. The difference is statistically significant( P < 0. 05). Conclusions The incidence of myocardial injury on children with sepsis,especially with severe sepsis,is high; The c Tn I value 0. 64 can be used as a cut-off point for screening severe sepsis; and Creatine Phosphate Sodium is recommended for myocardial protection treatment on children with severe sepsis.
引文
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[13] Markou N,Gregorakos L,Myrianthefs P. Increased blood troponin levels in ICU patients[J]. Curr Opin Crit Care,2011,17(6):454–463.
[14] Tanindi A,Cemri M. Troponin elevation in conditions other than acute coronary syndromes[J]. Vasc Health Risk Manag. 2011,7(8):597-603.
[15] King DA,Codish S,Novack V,et al. The role of cardiac troponin I as a prognosticator in critically ill medical patients:a prospective observational cohort study[J].Critical Care 2005,9(8):390-395.
[16] Ke-Wu D,Xu-Bo S,Ying-Xin Z,et al. The Effect of Exogenous Creatine Phosphate on Myocardial Injury After Percutaneous Coronary Intervention[J]. Angiology,2015,66(2):163-168.
[17]缪珀,孙斌,冯星.磷酸肌酸钠治疗新生儿窒息后心肌损伤的meta分析[J].中国当代儿科杂志,2012,14(3):172-176.
[18] Signoretti S,Di Pietro V,Vagnozzi R,et al. Transient alterations of creatine,creatine phosphate,N-acetylaspartate and high-energy phosphates after mild traumatic brain injury in the rat[J]. Mol Cell Biochem,2010,333(6):269-277.
[19]张彬,赵宏.磷酸肌酸的心肌保护机制及其在心脏疾病中的应用[J].医学综述,2008,14(2):262-264.
[20] Prabhakar G,Vona-Davis L,Murray D,et al. Phosphocreatine restores high-energy phosphates in ischemic myocardium:implication for off-pump cardiac revascularization[J]. J Am Coll Surg,2003,197(5):786-791.
[2]宋国维.小儿危重病例评分[J].中华急诊医学杂志,2003,12(5):359-360.
[3]刘娟,钱素云.小儿脓毒症和严重脓毒症发病情况单中心调查.临床儿科杂志,2010,28(1):26-29.
[4] John J,Woodward DB,Wang Y,et al. Troponin-I as a prognosticator of mortality in severe sepsis patients[J]. J Crit Care,2010,25(12):270–275.
[5] Lodha R,Arun S,Vivekanandhan S,et al. Myocardial cell injury is common in children with septic shock[J].Acta Paediatr,2009,98(3):478-481.
[6] Scott EC,Ho HC,Yu M,et al. Pre-existing cardiac disease,troponin I elevation and mortality in patients with severe sepsis and septic shock[J]. Anaesth Intensive Care,2008,36(3):51–59.
[7] John J,Awab A,Norman D,et al. Activated protein C improves survival in severe sepsis patients with elevated troponin[J]. Intensive Care Med,2007,33(11):2122–2128.
[8]张阳阳,王兴勇.非心源性重症患儿心肌损伤的早期诊断[J].检验医学与临床,2014,11(1):110-112.
[9]田慈,谢苗荣.脓毒症心肌损伤机制的研究进展[J].临床和实验医学杂志[J],2013,12(2):148-150.
[10]吴丹,金国强.脓毒症心肌损害发病机制研究进展[J].南昌大学学报(医学版),2010,50(12):119-122.
[11] Roongsritong C,Warraich I,Bradley C. Common causes of troponin elevations in the absence of acute myocardial infarction:incidence and clinical significance[J]. Chest2004,125(15):1877–1884.
[12] McLean AS,Huang SJ. Cardiac biomarkers in the intensive care unit[J]. Annals of Intensive Care,2012,2(1):1-11.
[13] Markou N,Gregorakos L,Myrianthefs P. Increased blood troponin levels in ICU patients[J]. Curr Opin Crit Care,2011,17(6):454–463.
[14] Tanindi A,Cemri M. Troponin elevation in conditions other than acute coronary syndromes[J]. Vasc Health Risk Manag. 2011,7(8):597-603.
[15] King DA,Codish S,Novack V,et al. The role of cardiac troponin I as a prognosticator in critically ill medical patients:a prospective observational cohort study[J].Critical Care 2005,9(8):390-395.
[16] Ke-Wu D,Xu-Bo S,Ying-Xin Z,et al. The Effect of Exogenous Creatine Phosphate on Myocardial Injury After Percutaneous Coronary Intervention[J]. Angiology,2015,66(2):163-168.
[17]缪珀,孙斌,冯星.磷酸肌酸钠治疗新生儿窒息后心肌损伤的meta分析[J].中国当代儿科杂志,2012,14(3):172-176.
[18] Signoretti S,Di Pietro V,Vagnozzi R,et al. Transient alterations of creatine,creatine phosphate,N-acetylaspartate and high-energy phosphates after mild traumatic brain injury in the rat[J]. Mol Cell Biochem,2010,333(6):269-277.
[19]张彬,赵宏.磷酸肌酸的心肌保护机制及其在心脏疾病中的应用[J].医学综述,2008,14(2):262-264.
[20] Prabhakar G,Vona-Davis L,Murray D,et al. Phosphocreatine restores high-energy phosphates in ischemic myocardium:implication for off-pump cardiac revascularization[J]. J Am Coll Surg,2003,197(5):786-791.