Objective: To analyze the risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns. Methods: A retrospective case series study was conducted. From January 2018 to August 2022, 361 patients with extensive burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 231 males and 130 females, aged 50 (36, 58) years, with total burn area of 45% (35%, 60%) total body surface area. According to the highest level of creatine kinase isoenzyme-MB (CK-MB) within 72 h post injury, the patients were divided into early myocardial injury group (CK-MB≥75 U/L, 182 patients) and non-early myocardial injury group (CK-MB<75 U/L, 179 patients). The following data of patients in the 2 groups were collected and analyzed, including gender, age, total burn area, admission time post injury, combination with shock on admission, combination with inhalation injury on admission; the main blood test indexes such as myocardial enzyme spectrum, blood routine, liver and kidney function, and electrolytes within 72 h post injury; and treatment outcomes and fatality rate. Data were statistically analyzed with chi-square test, independent sample t test, or Mann-Whitney U test. The multivariate logistic regression analysis was conducted to screen the independent risk factors for early myocardial injury and for death in patients with extensive burns. Results: There were statistically significant differences in gender, combination with shock on admission, total burn area, and admission time post injury of patients between the two groups (with χ2 values of 6.40 and 6.10, Z values of 5.41 and 3.03, respectively, P<0.05). There were no statistically significant differences in age, combination with inhalation injury on admission of patients between the two groups (P>0.05). The CK-MB, creatine kinase, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase, white blood cell count, neutrophil-to-lymphocyte ratio (NLR), alanine aminotransferase (ALT), aspartate aminotransferase, potassium, and hemoglobin within 72 h post injury were significantly higher than those in non-early myocardial injury group (with Z values of 15.40, 6.26, 7.59, 7.02, 2.64, 4.53, 4.07, 6.32, and 4.12, t=2.34, respectively, P<0.05), while the level of calcium was significantly lower than that in non-early myocardial injury group (Z=2.72, P<0.05). There were no statistically significant differences in other blood test indexes of patients between the two groups (P>0.05). The total burn area, admission time post injury, NLR and ALT within 72 h post injury were the independent risk factors for early myocardial injury in patients with extensive burns (with odds ratios of 1.03, 1.07, 1.04, and 1.02, 95% confidence intervals of 1.02-1.05, 1.00-1.11, 1.02-1.07, and 1.00-1.03, respectively, P<0.05). The fatality rate of patients in early myocardial injury group was 8.8% (16/182), which was significantly higher than 2.8% (5/179) in non-early myocardial injury group (χ2 =5.93, P<0.05). Early myocardial injury, age, combination with shock on admission, and combination with inhalation injury on admission were the independent risk factors for death in patients with extensive burns (with odds ratios of 3.60, 1.04, 6.53, and 3.14, 95% confidence intervals of 1.17-11.05, 1.01-1.07, 1.39-30.68, and 1.15-8.56, respectively, P<0.05). Conclusions: The total burn area, admission time post injury, NLR and ALT within 72 h post injury were the independent risk factors for early myocardial injury in patients with extensive burns. Patients with extensive burns with early myocardial injury have a higher fatality rate, and early myocardial injury is an independent risk factor for the patients' death.
目的： 探讨大面积烧伤患者发生早期心肌损伤的危险因素及早期心肌损伤对预后的影响。 方法： 采用回顾性病例系列研究方法。2018年1月—2022年8月，武汉大学同仁医院暨武汉市第三医院收治361例符合入选标准的大面积烧伤患者，其中男231例、女130例，年龄50（36，58）岁，烧伤总面积45%（35%，60%）体表总面积。根据伤后72 h内心肌型肌酸激酶同工酶（CK-MB）最高值，将患者分为早期心肌损伤组（CK-MB≥75 U/L，182例）和非早期心肌损伤组（CK-MB<75 U/L，179例）。收集并分析2组患者性别、年龄、烧伤总面积、伤后入院时间、入院时合并休克情况、入院时合并吸入性损伤情况，伤后72 h内心肌酶谱、血常规、肝肾功能、电解质等主要血液检查指标，治疗结局和病死率。对数据进行χ2检验、独立样本t检验或Mann-Whitney U检验。行多因素logistic回归分析，筛选大面积烧伤患者发生早期心肌损伤的独立危险因素和死亡的独立危险因素。 结果： 2组患者性别、入院时合并休克情况、烧伤总面积、伤后入院时间比较，差异均有统计学意义（χ2值分别为6.40、6.10，Z值分别为5.41、3.03，P<0.05），年龄、入院时合并吸入性损伤情况均相近（P>0.05）。早期心肌损伤组患者伤后72 h内CK-MB、肌酸激酶、乳酸脱氢酶、α-羟丁酸脱氢酶、白细胞计数、中性粒细胞与淋巴细胞比值（NLR）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶、钾、血红蛋白均明显高于非早期心肌损伤组（Z值分别为15.40、6.26、7.59、7.02、2.64、4.53、4.07、6.32、4.12，t=2.34，P<0.05），钙明显低于非早期心肌损伤组（Z=2.72，P<0.05）；2组患者其余血液检查指标比较，差异均无统计学意义（P>0.05）。烧伤总面积、伤后入院时间、伤后72 h内NLR和ALT均为大面积烧伤患者发生早期心肌损伤的独立危险因素（比值比分别为1.03、1.07、1.04、1.02，95%置信区间分别为1.02~1.05、1.00~1.11、1.02~1.07、1.00~1.03，P<0.05）。早期心肌损伤组患者病死率为8.8%（16/182），明显高于非早期心肌损伤组的2.8%（5/179），χ2=5.93，P<0.05。早期心肌损伤、年龄、入院时合并休克、入院时合并吸入性损伤均为大面积烧伤患者死亡的独立危险因素（比值比分别为3.60、1.04、6.53、3.14，95%置信区间分别为1.17~11.05、1.01~1.07、1.39~30.68、1.15~8.56，P<0.05）。 结论： 烧伤总面积、伤后入院时间、伤后72 h内NLR和ALT均为大面积烧伤患者发生早期心肌损伤的独立危险因素。伴早期心肌损伤的大面积烧伤患者病死率更高，早期心肌损伤是其死亡的独立危险因素。.