Application Of Troponin I In The Evaluation Of Myocardial Contusion After Closed Thoracic Trauma

Objective:Analysis of risk factors of myocardial contusion in closed thoracic trauma and its differentiation from myocardial infarction.Methods :Clinical data including cardiac troponin I(c Tn I)and lung CT results were collected from patients with closed chest trauma admitted to the emergency department of our hospital on January 1,2019 and acute myocardial infarction on June 30,2020.Inclusion criteria for the myocardial contusion group were:(1)a history of closed chest trauma;(2)18 years of age and above without systemic disease;(3)No hemodynamic disturbance;(4)No cardiovascular disease;(5)Peripheral blood oxygen saturation 93%;(6)c Tn I was measured within 12 h after visit for 3 consecutive days;(7)Perfecting cardiac ultrasound.Inclusion criteria for myocardial infarction group:(1)No history of chest trauma;(2)The patients met the diagnostic criteria for myocardial infarction and did not receive reperfusion therapy;(3)c Tn I was measured within 12 h after visit for 3consecutive days;(4)Perfecting cardiac ultrasound.Gender,age,rib fracture,pleural effusion and chest AIS score were compared between patients with closed thoracic trauma and patients with myocardial contusion,and the above factors were included in multivariate logistic regression analysis.P<0.05 was considered statistically significant.The ROC curve was drawn for risk factors obtained from multivariate logistic regression analysis,and the area under the curve,optimal critical value,sensitivity and specificity were obtained.The variation trend of c Tn I,abnormal rate of ventricular wall motion and ejection fraction were compared between the myocardial infarction group and the myocardial contusion group for 3 consecutive days.Results:Patients with closed thoracic trauma without rib fracture also had myocardial contusion,with a probability of 28.57%,but there was no statistically significant difference among different rib fractures.Multivariate logistic regression analysis showed that AIS≥3 was an independent risk factor for the first abnormal c Tn I level in patients with closed chest trauma(P < 0.05);There was no significant peak value of c Tn I in myocardial contusion patients for three consecutive days.The abnormal rate of ventricular wall motion in patients with myocardial infarction was higher than that in patients with myocardial contusion(P < 0.05),but there was no difference in ejection fraction.Conclusion:Patients with closed chest trauma with AIS≥3 should be alert to the risk of myocardial contusion.In patients with closed chest trauma,a significant peak in c Tn I dynamic changes and/or echocardiographic indications of abnormal ventricular wall activity should alert them to the risk of myocardial infarction.For patients with closed thoracic trauma who may be complicated with myocardial infarction,further improvement of coronary-artery examination should be carried out to evaluate,so as to provide basis for subsequent clinical treatment.