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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(P<0.01)。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(P<0.01)。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(P<0.01),轻度组血清CK-MB、cTnI及LEF与对照组比较无统计学意义(P>0.05)。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。
Objective: To investigate the dynamic changes of serum creatine kinase (CK-MB), troponin (cTnI) and left ventricular ejection fraction (LEF) after neonatal asphyxia and its clinical significance. Methods: From January 2007 to January 2009,28 cases of asphyxia children and 50 normal newborns were collected at 1 day, 3 days and 7 days after birth to collect femoral venous blood, serum CK-MB, cTnI and Test LEF. Results: ① The levels of serum CK-MB and cTnI in asphyxia group increased with the severity of the disease, peaked within one day after birth, decreased on the third day, and CK-MB and cTnI in the severe group on the seventh day were still significantly higher than those of the control Group (P <0.01). LEF in asphyxia group decreased with the aggravation of disease, reached the lowest within 24 hours after birth, and began to increase on the third day. However, the LEF in the seventh day severe group was significantly lower than that in the control group (P <0.01). ② Serum CK-MB, cTnI and LEF in severe asphyxia group were significantly different from those in control group and mild group (P <0.01). CK-MB, cTnI and LEF in mild group were not significantly different from those in control group (P> 0.05). Conclusions: ① Serum levels of CK-MB, cTnI and LEF are closely related to the degree of asphyxia, the more asphyxia, the higher the serum CK-MB and cTnI levels, and the lower the LEF level. ② Serum CK-MB, cTnI and LEF are the early sensitive indicators of heart injury in children. Combined determination of CK-MB, cTnI and LEF is a more comprehensive and reliable quantitative indicator of myocardial tissue injury after asphyxia, and the clinical intervention And early prognosis of great significance.