[논문]다발성 외상환자에서 폐좌상과 심근좌상의 상관관계

류지호; 염석란; 정진우; 민문기; 박맹렬; 김용인; 한상균; 박성욱

다발성 외상환자에서 폐좌상과 심근좌상의 상관관계
Correlation Between Pulmonary Contusion and Myocardial Contusion in Patients with Multiple Injuries 원문보기

大韓外傷學會誌 = Journal of the Korean Society of Tranumatology, v.24 no.1, 2011년, pp.31 - 36

류지호 (양산부산대학교병원 응급의학과) , 염석란 (부산대학교병원 응급의학과) , 정진우 (동아대학교병원 응급의학과) , 민문기 (양산부산대학교병원 응급의학과) , 박맹렬 (양산부산대학교병원 응급의학과) , 김용인 (양산부산대학교병원 응급의학과) , 한상균 (부산대학교병원 응급의학과) , 박성욱 (부산대학교병원 응급의학과)

Abstract ▼ AI-Helper

Purpose: This study was conducted to evaluate the correlations among pulmonary contusion severity, trauma score and cardiac troponin I (cTnI) level. Methods: We prospectively evaluated patients with multiple injuries who had been admitted to the emergency department (ED) from July 2007 to July 2008. We first measured the total creatinine kinase (CK), the MB fraction of CK (CK-MB), TnI, and myoglobin within 2 hours after the injury. We then checked the electrocardiogram, x-ray, and computed tomography (CT) results. Finally, we assessed the injuries as variables and then compared the results for patients with elevated TnI levels (group A) and patients whose TnI levels fell within the normal range (group B). Results: Eighty-six of the 92 patients admitted to the ED were enrolled. The pulmonary contusion score (PCS) was well correlated with $PaO_2/FiO_2$. TnI levels were correlated with PCS. When TnI levels were above 0.86 ng/ml, the mortality was estimated with 100% sensitivity and 86.1% specificity. Conclusion: Pulmonary contusion severity is correlated with TnI level. When the PCS is high and the cTnI level is elevated in multiple-injury patients, we recommend continuous cardiac monitoring and further evaluation

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가설 설정

Clinically, pulmonary contusion is often combined with myocardial contusion in multiple-injury patients. Therefore, we hypothesized that the severity of the pulmonary contusion might be a predictive factor of myocardial contusion in multiple-injury patients with chest trauma. The severity of the pulmonary contusion measured by 3D CT and pulmonary contusion score (PCS) in previous studies.

제안 방법

In the future, for more accurate results, data from large numbers of patients in multicenter trials is needed. Second, the study subjects did not have follow-ups such as serial checks of cardiac markers, routine laboratory results, and echocardiography for confirmation of the diagnosis after admission. Serial checks of cardiac markers stopped without routine follow-ups, as vital signs are stable.
(4,5,11) Multipleinjury patients usually present with pulmonary contusion and elevated serum cTnI levels or within normal range in the chest trauma. Therefore, the present study was performed to evaluate the correlation between pulmonary contusion score (PCS) and PaO₂/FiO₂ ratio (an index of arterial oxygenation efficiency that corresponds to ratio of partial pressure of arterial O₂ to the fraction of inspired O₂) that the parameter of pulmonary contusion severity, trauma scores and serum cTnI during the initial evaluation process in the emergency department.
We measured the total creatinine kinase (CK), MB fraction of CK (CK-MB), troponin I, and myoglobin within 2 hours after injuries and checked electrocardiogram, x-rays, and computed tomography (CT). We also assessed the chest abbreviated injury score (AIS), injury severity score (ISS), revised trauma score (RTS), pulmonary contusion score (PCS).(12) PCS compared with PaO₂/FiO₂ ratio and chest AIS.

대상 데이터

Eighty-six out of ninety-two patients admitted to the ED were enrolled in the study. Six patients were excluded because their pulmonary contusion diagnosis was uncertain.

데이터처리

Comparisons of the factors affecting the 2 groups were performed by linear regression analysis and the chi-square test or Fisher’s exact test. Comparison of PaO₂/FiO₂ ratio and chest AIS by PCS was performed by one-way ANOVA analysis. All tests were analyzed by using the SPSS statistical software (Version 12.
Comparisons of the factors affecting the 2 groups were performed by linear regression analysis and the chi-square test or Fisher’s exact test.

성능/효과

1. ROC curves of chest AIS, ISS, PCS, and RTS, ROC: receiver operating characteristic, AIS: abbreviated injury score, ISS: injury severity score, PCS: pulmonary contusion score, RTS: revised trauma score, RTS in the score systems was the most high as 0.779 of AUC (area under curve), but not significant statistically.

후속연구

Elevated serum cTnI in multipleinjury patients may be a risk factor for mortality. When PCS is high and troponin I levels are elevated, we would like to highlight the possibility of myocardial contusion, and the need for continuous cardiac monitoring and further evaluation.

참고문헌 (20)

Bernardis V, Kette F, Blarasin L, Pegoraro C, Coassin R. Isolated myocardial contusion in blunt chest trauma. Eur J Emerg Med 2004;11:287-90.

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Bertinchant JP, Polge A, Mohty D, Nguyen-Ngoc-Lam R, Estorc J, Cohendy R, et al. Evaluation of incidence, clinical significance, and prognostic value of circulating cardiac troponin I and T elevation in hemodynamically stable patients with suspected myocardial contusion after blunt chest trauma. J Trauma 2000;48:924-31.
Holanda MS, Dominguez MJ, Lopez-Espadas F, Lopez M, Diaz-Reganon J, Rodriguez-Borregan JC. Cardiac contusion following blunt chest trauma. Eur J Emeg Med 2006;13:373-6.
Rajan GP, Zellweger R. Cardiac troponin I as a predictor of arrhythmia and ventricular dysfunction in trauma patients with myocardial contusion. J Trauma 2004;57:801-8.
Sybrandy KC, Cramer MJM, Burgersdijk C. Diagnosing cardiac contusion: old wisdom and new insights. Heart 2003;89:485-9.

상세보기
Collins JN, Cole FJ, Weireter LJ, Riblet JL, Britt LD. The usefulness of serum troponin levels in evaluating cardiac injury. Am Surg 2001;67:821-5.
Meier R, Van Griensven M, Pape HC, Krettek C, Chawda M, Seekamp A. Effects of cardiac contusion in isolated perfused rat hearts. Shock 2003;19:123-6.

상세보기
Ognibene A, Mori F, Santoni R, Zuppiroli A, Peris A, Targioni G, et al. Cardiac troponin I in myocardial contusion. Clin Chem 1998;44:889-90.

상세보기
Tucker JF, Collins RA, Anderson AJ, Hauser J, Kalas J, Apple FS. Early diagnostic efficiency of cardiac troponin I and troponin T for acute myocardial infarction. Acad Emerg Med 1997;4:13-21.

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Velmahos GC, Karaiskakis M, Salim A, Toutouzas KG, Murray J, Asensio J, et al. Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. J Trauma 2003;54:40-50.
Ferjani M, Droc G, Dreux S, Arthaud M, Goarin JP, Riou B, et al. Circulating cardiac troponin T in myocardial contusion. Chest 1997;111:428-34.
Kim JJ, Shin JH, Jin W, Hyun SY, Lim YS, Yang HJ, et al. The value of grading of pulmonary contusion by the chest CT scanning. J Korean Soc Emerg Med 2004;15:452-5.
Miller PR, Croce MA, Bee TK, Qaisi WG, Smith CP, Collins GL, et al. ARDS after pulmonary contusion: Accurate measurement of contusion volume identifies high-risk patients. J Trauma 2001;51:223-30.
Mizushima Y, Hiraide A, Shimazu T, Yoshioka T, Sugimoto H. Changes in contused lung volume and oxygenation in patients with pulmonary parenchymal injury after blunt chest trauma. Am J Emerg Med 2000;18:385-9.
Edouard AR, Benoist JF, Cosson C, Mimoz O, Legrand A, Samii K. Circulating cardiac troponin I in trauma patients without cardiac contusion. Intensive Care Med 1998;24:569-73.

상세보기
Pai M. Diagnosis of myocardial contusion after blunt chest trauma using 18F-FDG positron emission tomography. The British Journal of Radiology 2006;79:264-5.

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Southam S, Jutila C, Ketai L. Contrast-enhanced cardiac MRI in blunt chest trauma: Differentiating cardiac contusion from acute peri-traumatic myocardial infarction. J Thorac Imaging 2006;21:176-8.

상세보기
Wu TT, Yuan A, Chen CY, Chen WJ, Luh KT, Kuo SH, et al. Cardiac troponin I levels are a risk factor for mortality and multiple organ failure in noncardiac critically ill patients and have an additive effect on the APACHE II score in outcome prediction. Shock. 2004;22:95-101.

상세보기
Masiakos PT, Hirsch EF, Millham FH. Management of severe combined pulmonary and myocardial contusion with extracorporeal membrane oxygenation. J Trauma 2003;54:1012-5.
Lindstaedt M, Germing A, Lawo T, von Dryander S, Jaeger D, Muhr G, et al. Acute and long-term clinical significance of myocardial contusion following blunt thoracic trauma: Results of a prospective study. J Trauma 2002;52:479-85.

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다발성 외상환자에서 폐좌상과 심근좌상의 상관관계
Correlation Between Pulmonary Contusion and Myocardial Contusion in Patients with Multiple Injuries 원문보기

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가설 설정

제안 방법

대상 데이터

데이터처리

성능/효과

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참고문헌 (20)

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다발성 외상환자에서 폐좌상과 심근좌상의 상관관계 Correlation Between Pulmonary Contusion and Myocardial Contusion in Patients with Multiple Injuries 원문보기

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가설 설정

제안 방법

대상 데이터

데이터처리

성능/효과

후속연구

참고문헌 (20)

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류지호 (3) 민문기 (2) 김용인 (3)

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다발성 외상환자에서 폐좌상과 심근좌상의 상관관계
Correlation Between Pulmonary Contusion and Myocardial Contusion in Patients with Multiple Injuries 원문보기

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