窒息新生儿心肌酶谱水平变化的临床分析

目的:通过测定不同程度、不同日龄窒息新生儿心肌酶谱水平的变化情况,了解窒息新生儿缺氧性心肌损伤的严重程度和临床意义,为寻找更客观、敏感地反应缺氧后心肌损害的指标提供理论依据,以利于临床及时地判断病情、指导治疗、改善预后。方法:采用全自动生化分析仪,选择58例窒息新生儿,分为两组,重度窒息组36例,轻度窒息组22例,分别于生后12 h内及生后第3天测定血清天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)活性,并将同期住院的无缺氧新生儿43例作为对照组进行比较分析。结果:窒息新生儿AST、LDH、CK、CK-MB、α-HBDH水平均有不同程度的升高,尤以CK-MB、AST较灵敏,且与缺氧程度呈正相关,生后第3天心肌酶水平大部分恢复,LDH水平恢复较慢。结论:血清心肌酶水平能较及时地反映窒息新生儿缺氧性心肌损伤的程度,生后第1天尽早测定其水平的变化,对判断病情、指导治疗有重要的临床意义。窒息后心肌损害为一过性,经及时复苏,保护心肌等治疗,心肌酶水平常在3 d内逐渐恢复,预后良好。

Clinical significance and changes of serum myocardial enzyme in newborns with asphyxia

Objective To investigate the activity and its clinical significance of serum myocardial enzyme in newborns with asphyxia.Methods The levels of serum myocardial enzyme of 58 cases newborns with asphyxia and 43 healthy newborns were delected within the fist 12 hours and the third day by Backman biochemistry analyzer.The neonates with asphyxia were divided into two groups,the severe asphyxia group and mild asphyxia group.The myocardial enzyme include:serum aminotransferase(AST),lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),α-hydroxybutyrate dehydrogenase(α-HBDH),etc.Results in asphyxia newborns group,the levels of AST 、LDH、CK、CK-MB、α-HBDH in peripheral blood were significantly higher than those of the control group,and the changes have statistical difference between the severe asphyxia group and mild asphyxia group.Conclusion The activity changes of serum AST 、LDH、CK、CK-MB、α-HBDH can reflect the degree of hypoxia cardiac damage in neonates with asphyxia timely.The hypoxia cardiac damage is usually transient,the prognosis of neonatal asphyxia can be fine through the effect treatment.Theactivitg of the most myocardial enzyme usually recover to the normal level in three days.