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[1]王兴元,曹洪兵,范丽娟,等.肌钙蛋白对髋部骨折患者短期和长期病死率的预测作用[J].医学研究与战创伤救治(原医学研究生学报),2015,17(04):368-371.[doi:10.3969/j.issn.1672-271X.2015.04.010]
　WANG Xing-yuan,CAO Hong-bing,FAN Li-juan,et al.Perioperative troponin I to predict short-term and long-term mortality in patients after hip fracture[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2015,17(04):368-371.[doi:10.3969/j.issn.1672-271X.2015.04.010]
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肌钙蛋白对髋部骨折患者短期和长期病死率的预测作用()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第17卷
期数:
2015年04期
页码:
368-371
栏目:
出版日期:
2015-07-20

文章信息/Info

Title:
Perioperative troponin I to predict short-term and long-term mortality in patients after hip fracture
作者:
王兴元; 曹洪兵; 范丽娟; 杨善进; 周红霞; 刘方刚; 陈步俊
212001 江苏镇江，解放军359医院内科
Author(s):
WANG Xing-yuan;  CAO Hong-bing;  FAN Li-juan;  YANG Shan-jin;  ZHOU Hong-xia;  LIU Fang-gang;  CHEN Bu-jun.
Department of Cardiovascular Diseases， 359 Hospital of PLA， Zhenjiang， Jiangsu 212001， China
关键词:
肌钙蛋白; 围术期; 髋部骨折; 病死率
Keywords:
troponin I;  perioperative;  hip fracture;  mortality
分类号:
R446.1；R683
DOI:
10.3969/j.issn.1672-271X.2015.04.010
文献标志码:
A
摘要:
目的 探讨骨折患者围术期肌钙蛋白升高对短期(30 d)和长期(3年)病死率的预测意义。方法 2005年1月-2010年1月，65岁或以上因髋部骨折的患者在入院时均进行登记，在入院时、术前和术后第1、3天完成心电图、肌钙蛋白检测并随访3年。结果 285例患者完成研究，其中101例(35.4%)出现肌钙蛋白升高:入院时肌钙蛋白已经升高者31例(30.7%)、术前升高者17例(16.8%)、术后肌钙蛋白升高者53例(52.5%)；153例(53.7%)出现心电图改变，包括65例(22.8%)ST段压低、11例(3.9%)ST段抬高及77例(27.0%)T波倒置。肌钙蛋白升高者其短期和长期病死率均高于正常者(18.8%比 3.3%，P<0.01，61.4%比 40.8%，P<0.01)，肌钙蛋白明显升高(肌钙蛋白＞0.15 μg/L)者30 d的病死率较轻度升高(肌钙蛋白在0.03~0.15 μg/L)者病死率高(21.9%比 13.5%，P<0.01)。肌钙蛋白升高是短期和长期病死率的独立预测因子。除ST段抬高外，缺血性心电图改变对病死率无影响。结论 围术期肌钙蛋白升高是短期和长期病死率的强烈预测因子，常规肌钙蛋白检测和及时诊断，有效治疗对这类易损患者有重要临床意义。
Abstract:
Objective To investigate the short-term and long-term prognostic value of perioperative troponin I (TnI) monitoring in hip fracture patients. Methods All patients with hip fracture were enrolled on admission from January 2005 to January 2010. Of 285 patients, older than 65 years, serum Troponin I and electrocardiogram (ECG) was evaluated on admission, before operation, and on first and second postoperative days. Median follow-up time was 3 years (1000 days). Results TnI elevation was detected in 101 patients (35.4%): already elevated on admission in 31 patients (30.7%), before operation in 17 patients (16.8%) and only operated in 53 patients (52.5%). Ischemic ECG changes were detected in 153 patients (53.7%), consisting of ST depression (n=65, 22.8%), ST elevation (n=11, 3.9%), or T-wave inversion (n=77, 27.0%). Patients with TnI elevation had higher short-term and long-term mortality (18.8% vs 3.3%, P<0.01, 61.4% vs 40.8%, P<0.01), mortality of 30 days being higher in patients with major (TnI≥0.15 μg/L) compare with mild (TnI=0.03-0.15 μg/L) TnI elevation (21.9% vs 13.5%, P<0.01). TnI elevation was the independent predictor of short-term mortality. ECG changes other than ST elevation did not affect mortality. Conclusion Perioperative TnI elevation is a strong predictor of short-term and long-term mortality. Routine TnI detection and earlier diagnosis together with effective treatment may improve survival of this fragile patient group.

参考文献/References:

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2015-07-20