新生儿窒息后心肌损伤的动态变化研究

目的:探讨新生儿窒息以后血清肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnI)和心脏超声左室射血分数(LEF)的动态变化及其临床意义。方法:对2007年1月～2009年1月28例窒息患儿和50例正常新生儿分别在生后1天内、第3天、第7天采集股静脉血测定血清中CK-MB、cTnI及检测LEF。结果:①窒息组血清CK—MB和cTnI水平均随着病情加重而升高,生后1天内均达到峰值,第3天开始下降,第7天重度组CK-MB、cTnI仍明显高于对照组(P0.01)。窒息组LEF随着病情加重而降低,生后24h内均达到最低值,第3天开始上升,但是第7天重度组LEF仍明显低于对照组(P0.01)。②重度窒息组血清CK-MB、cTnI及LEF与对照组和轻度组比较差异有统计学意义(P0.01),轻度组血清CK-MB、cTnI及LEF与对照组比较无统计学意义(P0.05)。结论:①血清中CK-MB、cTnI及LEF水平与窒息程度密切相关,窒息程度越重,血清CK-MB和cTnI水平越高,而LEF水平越低。②血清CK-MB、cTnI及LEF是患儿心脏损伤的早期敏感指标,联合测定CK-MB、cTnI及LEF是量化评价窒息后心肌组织损伤的较为全面、可靠的良好指标,对临床进行干预治疗和早期估计预后具有重要的意义。

Investigation on dynamic changes of cardiac damage in neonates with asphyxia

Objective:To explore the dynamic changes of serum creatine kinase isoenzyme (CK-MB),troponin (cTnI) and ejection fraction of left ventricle (LEF) and the clinical significance.Methods:The serum levels of CK-MB,cTnI and LEF in 28 neonates with asphyxia and 50 normal neonates from January 2007 to January 2009 were detected on the first,third and seventh day by taking femoral venous blood.Results:With the development of asphyxia,the serum levels of CK-MB and cTnI increased in asphyxia group,peaked within 24 hours after birth,decreased gradually from the third day,the serum levels of CK-MB and cTnI were significantly higher than those in control group on the seventh day (P<0.01).There was significant difference in serum levels of CK-MB,cTnI and LEF between severe asphyxia group and control group,mild asphyxia group (P<0.01).There was no significant difference in serum levels of CK-MB,cTnI and LEF between mild asphyxia group and control group (P>0.05).Conclusion:The serum levels of CK-MB,cTnI and LEF are related to severity of asphyxia,with the development of asphyxia,the serum levels of CK-MB and cTnI increase,while LEF decreases; the serum levels of CK-MB,cTnI and LEF are early and sensitive indexes of cardiac damage,joint detection of serum CK-MB,cTnI and LEF is a comprehensive and reliable index in quantitative evaluation of cardiac damage after asphyxia,which plays an important role in intervention treatment and evaluation of early prognosis.