新生儿缺氧缺血性脑病合并心肌损害相关因素分析

目的 :探讨新生儿缺氧缺血性脑病 (NHIE)伴心肌损害的心电图、血清心肌酶学改变与HIE分度的相互关系 ,心肌损害与窒息恢复时间的关系。方法 :对 16 5例HIE伴心肌损害的患儿出生后 4 8h以内的血清LDH(乳酸脱氢酶 )、CK (肌酶激酶 )、CK -MB (肌酶激酶同功酶 )、HBDH (a -羟丁酸脱氢酶 )的含量进行测定 ,并作心电图检查。结果 :心肌损害与窒息恢复时间呈明显正相关 ,P <0 0 1。 83例 (83/16 5 )患儿心电图出现改变 ,重度组改变分别大于轻、中度组 ,轻度组大于中度组。经方差分析显示 :心肌酶中CK、CK -MB变化与HIE的分度呈正相关性 ,差异显著 (P <0 0 5 ) ;12例 (12 /16 5 )病人于出生后 12h内出现心肌酶谱变化 ,而其中 8例的酶谱变化出现于生后 6h内。结论 :心肌损害和窒息恢复时间密切相关 ,常规检测心肌酶、心电图对HIE伴心肌损害的程度及预后判断 ,以及指导临床治疗有较大参考价值 ;生后 12小时内即可监测心肌酶学变化

Correlation Analysis of Neonatal Hypoxic-ischmic Encephalopathy with Myocardial Impairment

Objective:To study the relationship between alternation of the electrocardiogram and myocardial enzymogram among HIE patients with myocardial impairment and the degrees of hypoxic-ischemic encephalopathy(HIE).And further to evaluate the relationship between the recover time from asphyxia and myocardial injury.Methods:Electrocardiograms were examined and serum lactic dehydregenase(LDH)?creatine kinase(CK)?MB isoenzyme of creatine kinase(CK-MB)?hydroxybutyric dehydregenase(HBDH)were measured in 165 children of HIE with myocardial injury within first 48 hours of life.Results:myocardial injury was positively related to the recover time from asphyxia.83 cases(83/165,72.9%)had changes of electrocardiogram and the changes were more significant in the severe group o HIE with myocardial impairment than those in the moderate or mild ones,the changes of electrocardiogram in the mild one were more significant than those in the moderate one.The value of CK?CK-MB of myocardio enzymogram was positively related to the degrees of the HIE.Data was analysised by variance analysis and the results indicated that P<0.05.12 cases had alternation of enzymongram within first 12 hours of life,and 8 cases(8/12,66.7%)within first 6 hours.Conclusion:myocardial injury was closely related to the recover time from asphyxia.It is significantly valuable to carry out electrocardiogram and myocardial enzymogram routinely in determining the degree,management and prognosis of HIE with myocardial injury and the enzymogram should be taken within first 12 hours of life.