目的 探讨胸部钝挫伤患者血清中心肌损伤标志物的动态变化规律及其对心肌损伤的诊断意义。方法 选择武警江苏总队医院住院治疗的胸部钝挫伤82例为观察组, 全部胸部钝挫伤患者(ISS≥16分)根据有无合并心肌损伤分为两组, 即合并心肌损伤组(A组), 无合并心肌损伤组(B组), 分别对两组患者伤后3 h、6 h、12 h、48 h血清肌钙蛋白Ⅰ(cTnI)、心肌特异脂肪酸结合蛋白(H-FABP)、肌红蛋白(Mb)进行检测, 同法测定60名健康体检者血清相应指标作为对照组。结果 两观察组在不同时段血清cTnI、H-FABP及Mb浓度均高于对照组, 其中A组在伤后6~48 h, cTnI、H-FABP浓度均明显高于B组, 差异有统计学意义(P<0.01)。同时段A、B两组Mb浓度虽均高于对照组, 但两组组间比较差异无统计学意义。结论 血清cTnI、H-FABP、Mb的动态变化与胸部钝挫伤患者病情严重程度、变化趋势及预后具有良好相关性, 对心肌损伤早期诊断、治疗具有重要意义。

Objective To investigate the dynamic changes of myocardial injury markers in blunt trauma patients’ serum and its significance in diagnosis of trauma complicated by myocardial injury. Methods According to the presence or absence of myocardial injury, 82 cases of blunt trauma patients (ISS≥16) from December 2011 to December 2013 in this hospital were assigned to group A (presence of myocardial injury) and B (absence of myocardial injury). Troponin Ⅰ (cTnI), heart fatty acid-binding protein (H-FABP) , and myoglobin (Mb) were detected 3 h, 6 h, 12 h, 48 h after injury in serum of group A, B and 60 healthy persons (control group). Results Concentrations of cTnI, H-FABP and Mb were significantly higher than those in the control group at different times. Concentrations of cTnI and H-FABP in group A were significantly higher than those in group B (P<0.01). The concentration of Mb in group A, B was higher than that in control group, but the difference between the groups A and B was not significant (P＞0.05). Conclusions There is a good correlation between the dynamic changes of cTnI, H-FABP and Mb in serum and severity of illness, variation tendency and prognosis of blunt chest trauma patients, which is important for early diagnosis and treatment of myocardial injury. Combined with other examination Methods (X-ray, ECG, blood gas analysis, color Doppler echocardiography), detection of myocardial injury markers has a high clinical value in treatment of blunt chest trauma complicated by myocardial injury.