心脏热素升高最常与创伤患者的2型心肌梗塞有关
John T Culhane1, Jillian Drogan2, Raymond I Okeke3
1Surgery, Saint Louis University School of Medicine, Saint Louis, USA.
Cureus
|July 3, 2023
概括
在创伤患者中,心脏热素 (cTn) 升高通常表明2型心肌梗塞 (MI) 由于氧气供需问题,而不是1型MI. 测量cTn有助于识别需要更密切的心脏监测和护理的患者.
科学领域:
- 心脏病学 心脏病学
- 创伤医学 创伤医学
- 临床诊断 临床诊断 临床诊断
背景情况:
- 心脏中位素 (cTn) 对于诊断心肌梗塞 (MI) 是至关重要的.
- 1型心脏病发作源于冠状动脉事件,而2型心脏病发作源于在创伤中常见的氧气供需不平衡.
- 创伤患者cTn升高可能并不总是意味着需要再血管化的MI.
研究的目的:
- 为了确定哪些创伤患者可以从cTn测量中受益.
- 为了确定哪些cTn升高的患者需要进一步的缺血检查.
主要方法:
- 从2017年7月到2020年12月,对创伤患者的回顾性队列研究,其cTn升高 (超过0.032 ng/ml).
- 收集了基线特征,对cTn病因的心脏病学判断,以及患者的生存率.
- 使用后勤回归来进行多变量分析.
主要成果:
- 1.1%的创伤患者 (147/13746) 的cTn升高; 55.1%缺乏明确的测试指示.
- 只有1.5%的评估患者被诊断为1型心脏病发作;66.4%的升高cTn被归因于2型心脏病发作 (供需不匹配).
- 在65.7%的病例中,增加的cTn独立预测死亡 (aOR2.6,p=0.002) 和管理变化发生.
结论:
- 创伤患者的cTn升高通常是由于创伤相关因素 (如心动减速,贫血) 的2型心脏病发作.
- 升高的cTn确定了需要密集监测和支持性心脏护理的患者,尽管再血管化从未被指示.
- 在创伤中更有选择性的cTn排序可以提高识别需要专业心脏护理的患者的特异性.
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