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。

Diagnostic value of serum creatine kinase MB in patients with cardiac damage after electric injuries

OBJECTIVE: To investigate the incidence of cardiac damage and the diagnostic value of serum myocardial enzyme following electric injuries. METHOD: 32 patients with electrical contact injuries were evaluated by serial electrocardiograms (ECG), creatine kinase (CK) and creatine kinase MB isoenzyme (CK-MB) determinations. The patients were divided into two groups according to the ECG. RESULT: 17 patients showed abnormal ECG (Group A), and 15 normal ECG (Group B). Positive correlations were noted between CK, CK-MB and the size of electric burns. The difference of serum CK-MB and 1.1% of total CK (CK-MB in skeletal muscle) was defined as CK-MB difference. CK, CK-MB, CK-MB/total CK ratio and the CK-MB difference were significantly higher in group A than in group B (all P < 0.05). The CK-MB difference of 88% (15/17) patients in group A was more than 25 U/L, whereas that was 6.7% (1/15) in group B (P < 0.01). Six patients with CK-MB difference greater than 100 U/L had obvious cardiac damage. CONCLUSION: Cardiac damage is a common complication of electric injuries. The cardiac damage could be estimated by serum CK-MB, particularly by the CK-MB difference. The CK-MB difference might be a useful indicator for evaluating the severity of the cardiac damage.