Effect Of Elevated Troponin Ⅰ On Perioperative Cardiac Adverse Events In Patients With Multiple Trauma

Objective:Clinically,it is not uncommon for patients with multiple injuries to have elevated troponin I(cTnI),and some patients with multiple injuries often have elevated cTnl in the absence of underlying cardiac diseases.When performing emergency surgery on such patients,it is a great challenge for anesthesiologists in preoperative evaluation,induction of anesthesia,and intraoperative monitoring.The main purpose of this study was to investigate whether the elevated cTnl was associated with perioperative adverse cardiac events in patients with multiple trauma without cardiac disease.Methods:Medical records of the patients with multiple injuries who were admitted to Intensive care unti(ICU)and underwent emergency surgery in the anesthesia management system of the First Hospital of Jilin University during May 1,2015 to May 1,2018 were retrieved,and eligible patients were selected.Patients of all genders,18-65 years old,and was admitted to ICU due to multiple injuries.Injury Severity Score(ISS)was 16 points-25 points,preoperative monitoring troponin was valued,American Society of Anesthesiologists(ASA)was Ⅲ-Ⅳ.The anesthesia method was general anesthesia,and patients with previous history of heart disease such as coronary heart disease and heart failure,patients with subarachnoid hemorrhage due to multiple injuries and deaths within 24 hours after admission were excluded.A total of 87 cases were screened,and the serum cTnl concentration was 0.4ng/ml as the cut-off value,including 47 cases in the experimental group(cTnl>0.4ng/ml)and 40 cases in the control group(cTnl<0.4ng/ml).The cases of adverse cardiac events,blood routine,NT-terminal brain natriuretic peptide precursor(NT-proBNP),creatinine,Ejection fractions(EF)and the total length of stay in ICU were recorded.Results:There was no statistical significance in the incidence of perioperative adverse cardiac events between the experimental group and the control group(P>0.05),and there was no statistical significance with EF value and NT-proBNP(P>0.05).However,the length of stay in ICU of the experimental group was significantly longer than that of the control group(P<0.05),and the white blood cell and creatinine values were higher than those of the control group(P<0.05).Conclusion:Although there is no significant correlation between cTnl elevation and perioperative cardiac adverse events in patients with multiple injuries in non-cardiac diseases,there is no significant correlation between cTnl elevation and EF value and NT-proBNP.However,the length of stay in ICU of the experimental group was significantly longer than that of the control group,and the WBC and creatinine values were higher than those of the control group.As an anesthesiologist,we should still pay attention to the assessment of the overall situation and the protection of the functions of each system during the perioperative period,and more attention should be paid to the circulatory and renal functions.