肠脂肪酸结合蛋白和肌酸磷酸激酶在肠梗阻诊断中的意义

目的：探讨肠脂肪酸结合蛋白（IFABP）、肌酸磷酸激酶（CK）在肠梗阻诊断中的意义。方法：将27例肠梗阻患者分为两组：观察组1（手术发现肠坏死行肠切除、肠吻合术）12例,观察组2（行手术治疗发现无肠坏死者）15例,分别在入院时、术后第1d、术后第3d采静脉血,检测血标本中IFABP及CK的含量;正常体检者15例作为对照组,采静脉血1次。结果：两观察组入院时血清IFABP及CK水平均高于正常对照组;术后第1d,两观察组IFABP水平均降至正常,CK水平较术前无明显变化;术后第3d,两观察组IFABP水平与对照组无明显差别,而CK水平较前明显降低。结论：IFABP及CK是诊断肠缺血、肠坏死的敏感指标,且IFABP对肠梗阻术后的预后有指导意义。     

心脏瓣膜转换术围术期内皮素和肌酸磷酸激酶同工酶动态变化的 …

测定体外循环心脏手术围术期内皮素 (ＥＴ)、肌酸磷酸激酶同工酶、ＣＫ ＭＢ值 ,以了解其动态变化规律 ,并观察主动脉阻断对心脏局部及全身释放内皮素的影响探讨其临床意义。资料与方法　 2 6例风湿性心脏瓣膜病患者 ,男 12例 ,女 14例 ,年龄 2 0～6 0岁。术前半小时肌注哌替啶 1ｍｇ/ｋｇ、东莨菪碱 0 0 0 6ｍｇ/ｋｇ。以咪唑安定、芬太尼、维库溴铵及异氟醚吸入慢诱导 ,芬太尼、维库溴铵间断静注及异氟醚间断吸入维持麻醉。体外循环用Ｓａｒｎｓ740 0型人工心肺机 ,灌注方式为非搏动性血液灌注 ,中度血液稀释 ,中度低温 ,主动脉阻断时间 …     

ICU重症患者血清CK、MYO升高的临床意义

目的了解ICU重症患者的血清肌酸磷酸激酶(CK)、肌红蛋白(MYO)升高的流行病学特征和临床意义。方法回顾性分析符合入选标准的3 282例ICU重症患者,分析患者不同性别、年龄、手术方式及不同疾病的CK、MYO升高的发生率。结果 CK、MYO升高的总发生率分别为55.7%和29.8%;在性别上,男性CK、MYO升高的发生率高于女性(P0.001);21岁以上年龄段中,CK升高的发生率高于20岁以下患者,41～60岁年龄段患者中,检测到的MYO水平高于20岁以下(P0.001);手术以心脏、颅脑、血管、肺部食道纵膈CK、MYO的升高发生率较高,心脏最高,分别为96.3%和64.9%;非手术患者CK依次以MODS、脑血管意外、脓毒症较高,MYO则为MODS、脓毒症、脑血管意外。结论 ICU重症患者肌肉损伤的发生率较高,应加强术后及危重症患者血清CK、MYO的监测。     

电烧伤患者血清可溶性白细胞介素2受体水平的变化

一、资料与方法1. 临床资料与分组:选择笔者单位收治的电烧伤患者26例,年龄 16~55岁。按致伤电场强度分为 3组 (表 1),另按Ⅲ度烧伤面积分为 3组 (表 2)。将健康献血员 10名 (健康组)和重度烧伤 (非电烧伤 )患者 10名 (烧伤组 )作为对照,男∶女均为 8∶2,健康组年龄(31±6)岁,烧伤组 (30±10)岁。有其他全身性疾病者及妊娠期妇女、严重复合伤患者均未被纳入本研究。表 1 按不同致伤电场强度分组的电烧伤患者一般情况(x±s)组别例数男∶女年龄(岁)Ⅲ度烧伤面积(%TBSA)<1. 5kV/m组 7 6∶1 28±12 6±41. 5~15. 0kV/…     

烧伤患者血清心肌钙蛋白T变化的临床意义

目的　评估血清心肌钙蛋白T(cardiactroponinTcTnT)对烧伤患者心肌损伤的诊断价值。　方法　 6 2例烧伤患者按伤情分为轻中度、重度和特重度 3组 ,于伤后 1、3、7、14d用放免法分别测定血清cTnT和肌酸磷酸激酶同功酶 (CK -MB) ,同期进行超声心动图和心电图检查并与 2 0例正常人员对照。　结果　 (1)与正常组比较 ,重度和特重度各时相点的cTnT均显著升高 (P <0 0 1) ,最高值可达 6 0倍 ,而且升高幅度与伤情相一致。 (2 )CK -MB的变化与cTnT大致相似 ,其最大值只有正常对的 6倍。 (3)特重度组中 9例、5例患者超声心动图和心电图表现异常。　结论　cTnT与CK -MB的动态变化均能较好反映烧伤患者的心肌损伤程度 ,cTnT的特异性和敏感性更高 ,因而更为可靠     

大鼠肢体电烧伤模型的病理学变化

电烧伤常造成广泛的深部组织和血管受损，导致进行性和继发性组织坏死，最终往往导致截肢（指、趾）等严重毁损性后果。我们通过自制的电烧伤装置，了解大鼠肢体电烧伤的组织病理改变及转归规律，为改进电烧伤的治疗提供研究模型。     

严重烧伤早期大鼠心脏交感神经电生理活动的变化

目的 研究严重烧伤早期大鼠心脏交感神经电生理活动的变化规律及其机制,探讨心脏交感神经活动的变化与严重烧伤后心脏损伤的关系。方法 SD大鼠随机分为正常组（6只）、假伤组（18只）和烧伤组（20只）,在烧伤组大鼠背部制成30％TBSA的Ⅲ度烫伤。应用神经电生理方法记录心脏交感神经的放电活动,同时观察心电图和心肌力学指标的变化。结果 严重烧伤后大鼠心脏交感神经传出活动即刻增强,而传入活动经一潜伏期（约90s)后也显增强,且传入活动增强后传出活动进一步增强。交感神经传出、传入活动增强约持续3h左右,而后显降低,传入活动的变化早于传出活动的变化。部分大鼠在烧伤后1h左右,心脏交感神经放电活动除平均值增加外,波动性增大,呈间歇性“爆发”现象,其中4只大鼠在放电爆发性增加的同时频发室性早搏。烧伤后左心室收缩压峰值和左室内压最大上升／下降速率显降低。结论 严重烧伤后早期心脏交感神经传入和传出活动均增强,且传入活动的变化对传出活动的变化有一定的影响。心脏交感神经电生理活动增强可能是严重烧伤后早期心脏损伤的原因之一。     

腕部电烧伤的修复

目的 探讨腕部电烧伤的修复方法及不同皮瓣的具体应用。方法 对1990年7月至2002年7月治疗腕部电烧伤的不同修复方法进行总结。结果 采用腹部轴型皮瓣和不带主要血管的前臂皮瓣修复Ⅰ、Ⅱ型腕部电烧伤，截肢率1．92％；腹部H型双蒂皮瓣修复Ⅲ型腕部电烧伤，截肢率54．66％；Ⅳ型，放弃皮瓣治疗，全截肢。结论 胸脐皮瓣、髂腹股沟皮瓣是修复腕部Ⅰ、Ⅱ型电烧伤较好的方法；不带主要血管的前臂皮瓣修复腕部电烧伤有一定的适应证，尤其适用于小儿和老人；腹部H型双蒂皮瓣适宜于修复Ⅲ型腕部电烧伤，重建腕部血管是减少Ⅲ型腕部电烧伤截肢率的有效方法。保留伤肢长度对Ⅳ型电烧伤功能有一定意义。     

Elevated serum creatine phosphokinase is associated with mortality and inotropic requirement in critically injured adults

BackgroundHemeproteins such as free myoglobin can undergo autoxidation and catalyse lipid peroxidation, increasing oxidative stress. Creatine phosphokinase (CPK) elevation is a marker for free myoglobin after myocyte damage. Since oxidative injury is a key mechanism of injury-related organ dysfunction, we hypothesised that serum CPK levels correlate with mortality and need for inotropic medication and duration of inotropic support, i.e. shock, among critically injured patients.MethodsWe conducted a retrospective review of 17,847 patients admitted to a single Trauma Intensive Care Unit over 9 years. 2583 patients with serum CPK levels were included in the analysis. Patient data were collected continuously into an electronic ICU repository. Univariate analysis was accomplished using Spearman correlation and the Mann–Whitney U test. Propensity score adjustment models accounting for potential confounders were used to assess the independent effect of CPK level on mortality, need for inotropic support, and duration of inotropic support.ResultsMedian CPK was significantly higher in patients who died (916 [IQR 332, 2472] vs. 711 [253, 1971], p = 0.004) and in those who required inotropic medications (950 [353, 2525] vs. 469 [188, 1220], p < 0.001). After adjusting for propensity score and potential confounders the odds of mortality increased by 1.10 (95% CI 1.02–1.19, p = 0.020) and the odds of inotropic medication use increased by 1.30 (95% CI 1.22–1.38, p < 0.001) per natural log unit increase in CPK. There was a significant association between CPK level and duration of inotropic support (Spearman's rho .237, p < 0.001) that remained significant in a propensity score-adjusted model.ConclusionIn critically injured patients, elevated serum CPK level is independently associated with mortality, need for inotropic medication, and duration of inotropic support. This study is the first to evaluate the relationship of CPK level and mortality in addition to surrogate measures of shock in a population of critically injured patients. If these associations are verified prospectively, there may be a role for treatment with hemeprotein reductants, such as paracetamol, to mitigate the effects of shock and end-organ dysfunction.     

Hyperkalemia in electrical burns: A retrospective study in Colombia

Introduction

Classically, hyperkalemia has been regarded as a complication in patients with electrical burns. The etiology of hyperkalemia includes metabolic acidosis, destruction of red blood cells, rhabdomyolysis and the development of renal failure. The purpose of this study was to determine the prevalence of hyperkalemia within the first 24 h after electrical burn injury and to evaluate the possible association of serum potassium concentration with cutaneous burn size (%TBSA) and serum creatine phosphokinase (CPK) concentration.

The effect of oral N-acetylcystein on prevention of extensive tissue destruction in electrical burn injury

Background

Electric burn patients usually suffer permanent injury and sequelae. Salvage of the zone of stasis is an important topic in the treatment of burn patients. N-Acetylcysteine (NAC), as an antioxidant, has effect on the saving zone of stasis and extensive rhabdomyolisis. The aim of this study was therefore to evaluate the effect of oral NAC on tissue destruction indicators in an electric burn rat model.

Changes in serum and exudate creatine phosphokinase concentrations as an indicator of deep tissue injury: a pilot study

Deep tissue injury (DTI) is difficult to detect in the early phase. Creatine phosphokinase (CPK) as a muscle enzyme could represent a promising indicator of DTI. However, serum CPK levels reflect the systemic condition rather than the local wound environment. Wound exudates can be indicative of the local wound environment. This study aimed to investigate the usefulness of CPK levels in wound exudates as an indicator of DTI. Rats were divided into control, 6 hours 10‐kg and 6 hours 20‐kg loading groups. Serum samples were obtained before wounding, and at 8 and 12 hours, and 1, 2 and 3 days after wounding, while exudate samples were obtained on days 2 and 3. Serum CPK levels were markedly increased in the 10‐kg and 20‐kg groups at 8 and 12 hours after loading compared with the baseline value and control group, but decreased to the normal level on day 1. In both loading groups, exudate CPK levels were high on day 2 and decreased on day 3. Muscle necrosis was more severe in the 20‐kg group than in the 10‐kg group by histological examination. This is the first study to indicate the potential of CPK in wound exudates as an indicator of DTI.     

Enzymatic changes in the cerebrospinal fluid as indices of pathological change

Summary Enzymatic determinations in cerebrospinal fluid (CSF) of lactic dehydrogenase (LDH), creatine phosphokinase (CPK) and creatine kinase BB (CK-BB) were performed on 94 patients presenting with a range of disorders of the central nervous system. Enzyme results from 37 patients undergoing myelography were used as controls. The highest concentration of these enzymes appeared in patients with the most severe brain injury. In head-injured patients with a Glasgow Coma Score (GCS) of 3 to 7, only the CK-BB correlated with the degree of injury and with the ultimate outcome. Within the subgroup of spinal cord injuries none of the enzymes correlated with the severity of neurological injury. However, patients with acute spinal cord trauma who demonstrated CSF CK-BB values greater than 10 U/litre had never recovered. The present study confirms that CSF CK-BB seems to be a sensitive index of acute brain damage, but it reflects best the extent of CNS tissue disruption rather than the severity of neurological deficits.     

头面部和双手电弧烧伤患者不同治疗阶段心理反应差异的研究

目的:对头面部及双手电弧烧伤住院患者在伤后不同治疗阶段进行心理问卷调查,了解患者焦虑和抑郁的发生状况.方法:对20例成人头面部及双手电弧烧伤住院患者于入院初(伤后24 h内),扩创术前(伤后第5天)、恢复期(伤后2周～1个月)3个不同治疗阶段,采用Zung氏焦虑和抑郁评定量表进行心理问卷调查,统计分析存在焦虑、抑郁状态的存在情况.结果:20例患者在入院初(伤后24 h内)、扩创术前(伤后第5天)及恢复期(伤后2周～1个月)3个治疗阶段均存在焦虑或(和)抑郁倾向;患者在入院初(伤后24 h内)的焦虑和抑郁状况最明显,焦虑和抑郁评分(37.60±7.06和36.90±8.48)均明显高于扩创术前(33.45±6.15±和34.70±8.24)和恢复期(28.75±5.63和29.30±5.69),差异均有显著性(P均＜0.05).结论:头面部及双手电弧烧伤住院患者伤后24 h内焦虑抑郁状态相对于其他诊疗阶段重,建议采取相应的心理护理干预措施.     

血清心型肌酸激酶对判断电损伤后心脏损害的临床价值

目的探讨电损伤后心脏损害的发病情况及判断电损伤后心脏损害的血清酶学指标。方法研究了３２例电接触性损伤患者的心电图、血清肌酸激酶（ＣＫ）和心型肌酸激酶（ＣＫＭＢ）活性。结果１７例患者有心电图异常（Ａ组）,１５例患者心电图基本正常（Ｂ组）。将测定的血清ＣＫＭＢ减１１％总ＣＫ的差定义为ＣＫＭＢ差值。Ａ组ＣＫ、ＣＫＭＢ、ＣＫＭＢ／ＣＫ比率和ＣＫＭＢ差值明显高于Ｂ组（全部：Ｐ＜００５）。Ａ组８８％的患者ＣＫＭＢ差值大于２５Ｕ／Ｌ,Ｂ组为６７％（Ｐ＜００１）。结论（１）心脏损害是电损伤的常见并发症,高压电更易于导致心脏损害;（２）血清ＣＫＭＢ,特别是ＣＫＭＢ差值可用于评价电损伤患者的心脏损害。     

电击伤后并发脑损伤的临床分析

目的 探讨电击伤后并发脑损伤的发病特点及诊治方法。方法 收集笔单位近年收治的138例电击伤思的临床资料，根据临床表现及影像学检查结果，判断其是否并发脑部损伤，并将受损程度分为轻、中、重、特重度4类。分析电流出入口部位及电压高低与脑损伤的关系，提出可能的致病原因。根据诊断结果，选择合适的治疗方案。结果本组患中，有106例并发脑损伤，4例为重度，其余为轻、中度，影像学检查可见脑部阳性病变。致伤电压的高低、电流出入口部位与脑损伤发生率关系不大，但二与脑损伤程度有密切关系。本组患经治疗，131例治愈，7例死亡，但无1例因脑损伤而致死。结论 高压电击伤后脑损伤的发生率较高，其原因可能与电流对脑部的直接损害、机械性损伤、电流所致心肺疾病、大面积烧伤均有关，早期、正确地诊断、治疗，是减少死亡率、致残率的关键。     

Analysis of factors influencing limb amputation in high-voltage electrically injured patients

Background

Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients.

Methods

Eighty-two high-voltage electrically injured patients were admitted to our hospital during a 17-year period. A retrospective analysis of the possible related risk factors between amputation and non-amputation patients was performed.

Results

A total of 68 patients were enrolled for analysis. Thirteen patients underwent limb amputations. Multivariate analysis of the risk factors between amputation and non-amputation groups showed statistical significance for day 1 creatine kinase-isoenzyme MB (CK-MB) level. A serum CK-MB level above 80 ng/ml predicted high risk of limb amputation with high specificity (84%) and sensitivity (77%). Only one patient with a remarkable decrease of creatine kinase (CK) and CK-MB levels after fasciotomy avoided a major limb amputation.

Conclusion

Our results suggest that CK-MB level is an independent factor for prediction of limb amputation. We suggest that the addition of CK-MB evaluation to clinical symptoms screening may be a valuable method to early detection of muscle damage.