缺氧缺血性脑病对新生儿的心电图和心肌酶学的影响及其临床意义

目的探讨缺氧缺血性脑病（HIE）对新生儿的心电图（ECG）和心肌酶学的影响及其临床意义。方法选自2010年1月~2012年12月间在本院新生儿科被确诊为HIE的84例新生儿，其中轻度组46例，重度组38例，对照组54例。，采用不同生物化学方法检测各组新生儿血清中的肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）和心肌肌钙蛋白T（CTnT）的活性，利用非侵人性床边常规ECG记录各组ECG变化特征，并作组间比较分析。结果与对照组比较，轻度组有58．70％患儿的ECG出现异常变化（PG0．01），ECG的类型主要为I级（34．78％）和Ⅱ级（19．57％），I级又显著多于Ⅱ级；患儿血清中CK和CK-MB水平略有增高（P均〉0．05），但cTnT值显著高于对照组（PG0．01）。在重度组有100％新生儿的ECG出现ST段改变，甚至出现病理性Q波、束支传导阻滞，其ECG异常发生率不仅高于对照组，还显著高于轻度组（P均〈0．01），ECG的特征主要为Ⅲ级（50．00％）和Ⅳ级（39．47％）；血清中的CK、CK-MB和cTnT值不仅显著高于对照组，也明显高于轻度组（P均〈0．01），特别是CK-MB值，超过对照组的6倍，cTnT值超过对照组的20倍。从临床病情看轻度组中没有死亡病例出现，而重度组出现11例患儿死亡（28．95％）。结论HIE的发生引起新生儿出现异常ECG和心肌酶学水平改变，提示患儿心肌组织可能受到损伤，HIE病情越深，患儿心肌受损越严重。监测HIE患儿ECG具有实用性和直观性，测定患儿血清中cTnT具有显著的敏感性和特异性，二者在诊断、治疗有关HIE发生可能诱使心肌受到损伤等方面具有非常重要的临床意义。

Clinical significances and effects of hypoxic-ischemic encephalopathy on electrocardiography and myocardial enzymes in neonates

Abstract] Objective To investigate the clinical significances and effects hypoxic-ischemic （HIE） on electrocardiography （EC~） and myocardial enzymes in neonates. Methods 84 HIE neonates in our hospital from January 2010 to December 2012 were enrolled, including 46 HIE mild cases and 38 HIE severe cases. 54 healthy children were chosen as control group. The creatine kinase （CK） and creatine kinase isoenzyme （CK- MB） as well as cardiac troponin T （CTnT） were measured using different biochemical ways, and ECGs were recorded by non-invasion routine means in HIE neonates and control healthy children, which were compared and analyzed in different groups. Results Compared with control group, ECGs were abnormal in 58. 70% of cases in HIE mild degree group （P~0. 01）,which were mainly shown to grade I （34. 78%） and I] （19. 57%） in abnormal types of ECGs. Except for CK and CK-MB level were slightly increased （P of all ~0. 05）, cTnT value was significantly ascended in HIE mild degree （P~0. 01）. In HIE severe degree group, ECGs were ab- normal in 100. 00% of cases in HIE severe group （P~0. 01）,which were mainly included changes of ST seg- ment, pathological Q wave and bundle branch block. Percentage of abnormal ECGs were increased more signifi- cantly not only than control group and HIE mild degree group, which were characterizated in grade Ill （50. 00%） and IV （39. 47%） in HIE severe degree group. Moreover,CK and CK-MB as well cTnT value were significantly increased to compared with contol group and HIE mild degree group in HIE severe degree group （P of all 〈0. 01, respectively）. Extraordinarily, CK-MB and cTnT values were respectively exceeded 6 times and 20 times to that in control group. Finally, there was no dead case in HIE mild degree group, but there were 11 case （29. 95% ） to die in HIE severe degree group during hospital stay according to clinical outcome of final statisticsConclusions Abnormal ECG and cardiac enzymes levels are found in HIE and can lead to severe clini- cal outcome due to myocardial damage in increasingly poor HIE. Early detection of ECG and cTnT respectively had more high practicability and sensitivity as well as specificity, which were contributed important clinical sig- nificance to diagnosis, treatment and prognosis about neonates taking HIE and injuring heart.