地震致挤压伤者血清肌酸激酶检测的意义

目的 分析不同血清肌酸激酶（CK）水平地震致挤压伤者的临床特点。方法回顾性分析201例地震致挤压伤者的临床资料。依据血清CK水平将患者分为3组：Ⅰ组（CK〈1000U／L）150例；Ⅱ组（CK1000～10000U／L）31例；Ⅲ组（CK〉10000U／L）20例。比较3组临床特点和血生化指标，并对地震致挤压伤者血清CK水平与各生化指标进行相关性分析。结果Ⅲ组多数为复合伤及有肢体肿胀，40％（8／20）患者行筋膜切开术，35％（7／20）患者接受截肢术，80％（16／20）患者发生急性肾衰竭，65％（13／20）患者行透析治疗，均高于Ⅰ、Ⅱ组。Ⅲ组血清肌酐（SCr）、尿素氮（BUN）、丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、血钾、血磷和乳酸脱氢酶（LDH）较Ⅰ、Ⅱ组升高（P〈0．05），血钙较Ⅰ、Ⅱ组降低（P〈0．05）。地震致挤压伤者血清CK水平与SCr、BUN、ALT、AST、LDH、血钾及血磷呈正相关（r分别为0．44、0．45、0．54、0．64、0．46、0．48、0．36，P〈0．01），与血钙呈负相关（r为-0．34，P〈0．01）。结论CK可以作为评估地震致挤压伤严重程度和选择治疗的一个重要指标。

Significance of determination of serum creatinkinase of the paitents with crush injury in earthquake

Objective To analyse the clinical features of the paitents with crush injury in earthquake with different serum level of creatinkinase （CK）. Methods The clinical data of 201 paitents with crush injury in earthquake were analyzed retrospectively. These patients were divided into three groups according to the serum level of CK： group Ⅰ（CK〈1000 U/L）, group Ⅱ（CK 1 000U/L- 10 000 U/L）, group Ⅲ （CK〉 10 000U/L）. The clinical features and biochemical indexes were compared, and the correlation between serum level of CK with biochemical indexes was analyzed. Results Most of patients in group Ⅲ had combined injuries and limb edema. Incidence of fasdotomy, amputation,acute renal failure and the need for hemodialysis were 40%,35%, 80%, and 65% respectively, which were higer than those in group Ⅰ and group Ⅱ. In group Ⅲ, the serum level of creatinine （SCr）,blood urea nitrogen （BUN）,alanine aminotransferase（ALT）, aspartate aminotransferase （AST）, kalium（K ＋ ）, phosphrus （PS ＋ ）, and lactic dehydrogenase （LDH） were higher than those in group Ⅰ and group Ⅱ （P〈0. 05）, The serum level of calcium （Ca2＋） was lower than those in group Ⅰ and group Ⅱ（P〈0. 05）. There was a positive correlationship between the serum level of CK and SCr,BUN. ALT. AST. LDH,K＋ and p3＋ （r= 0.44,0.45,0.54,0.64,0.46,0.48,0.36,P~0.01）, there was a negatively correlationship between the sertwa level of CK and Ca2＋ （r= -0. 34,P〈.0 01）. Conclusion CK is one of important markers for severity of earthquake casualty and selection of treatment.