心肌挫伤诊断指标的实验研究(1)
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[摘要] 目的：探讨心肌挫伤的病理生理学改变，提出早期的诊断指标并评价相关指标的真实性及诊断价值。方法：选用新西兰大白兔36只，采用撞击法制备心前区闭合性损伤模型。测定伤前及伤后1、6、12、24、48 h的心电图、超声心动图、漂浮导管、肌钙蛋白Ⅰ、CK-MB改变，依据病理结果，将创伤动物分为心肌挫伤组和非心肌挫伤组，比较上述诊断指标最早出现阳性结果的时间及其真实性和诊断价值。结果：心肌挫伤后1 h心电图出现ST-T改变等非特异性改变且阳性结果动物数量最多，灵敏度为58.8%，特异度为75%，阴性预测值为56.2%。伤后1 h超声心动图提示EF下降、室壁异常运动、肺动脉估测压差升高等，伤后6 h阳性结果动物数量最多，灵敏度为93.3%，特异度为78.6%，阴性预测值为91.7%。漂浮导管检测提示，伤后1 h中心静脉压及肺动脉压明显升高且阳性结果动物数量最多，灵敏度为100%，特异度为83.3%，阴性预测值为100%。伤后6 h肌钙蛋白Ⅰ明显升高且阳性结果动物数量最多，灵敏度为94.1%，特异度为100%，阴性预测值为92.3%。伤后6 h CK-MB明显升高，12 h血清CK-MB阳性结果动物数量最多，灵敏度为88.2%，特异度为66.7%，阴性预测值为80%。结论：漂浮导管、超声心动图、心电图均能较早检测出心肌挫伤，而肌钙蛋白Ⅰ和CK-MB则稍晚。漂浮导管检测心肌挫伤的真实性和诊断价值最好，其次为肌钙蛋白Ⅰ和超声心动图对肺动脉估测压差的检测，CK-MB和心电图真实性和诊断价值较差。
[关键词] 心肌挫伤；灵敏度；特异度；阴性预测值
[中图分类号] R965 [文献标识码] A [文章编号] 1673-7210(2011)06(c)-035-03
The empirical study of myocardial contusion′s diadynamic criteria
WANG Bin1, CHEN Can2 , XU Fengdan2*
1.Houjie Hospital, Guangdong Province, Dongguan 523945, China; 2.Affiliated Hospital of Guangdong Medical College, Zhanjiang 524023,China
[Abstract] Objective: To study the pathophysiology of myocardial contusion, find out the early diadynamic criteria and evaluate their validity and diagnostic value. Methods: Thirty-six healthy rabbits were selected and impacted by self-made impact machine to produce myocardial contusion. The changes of the ECG, echocardiography, floating catheter, troponin-Ⅰ, CK-MB were observed respectively at time phases as before and 1,6,12,24,48 hours after wounding. The rabbits wer divided into MC group and non-MC group according to the pathology. Compared the earliest time of the diadynamic criteria and evaluated their validity and diagnostic value. Results: After myocardial contusion, most rabbits appeared ST-T changes in ECG at 1 hour. The sensitivity was 58.8%, the specificity was 75%, the negative predictive was 56.2%. The echocardiography appeared changes such as the EF dropped etc at 1 hour, but most rabbits appeared changes at 6 hour. The sensitivity was 93.3%%, the specificity was 78.6%, the negative predictive was 91.7%. Most rabbits′ central venous pressure and pulmonary arterial pressure measured by floating catheter raised at 1 hour ......
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