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目的观察心肌酶谱在窒息后新生儿缺氧性心肌损伤中的变化及其临床意义。方法选择窒息新生儿40例,按照窒息程度分为2组分别于生后24h内和生后第3d、第7d检测血清肌酸激酶(CK)、肌酸激酶心型同工酶(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH),并将同期住院的非缺氧新生儿20例,作为对照组进行比较分析。结果(1)轻度窒息组和重度窒息组患儿,出生后24h内及生后第3d的CK、CK-MB、LDH、α-HBDH均明显升高,与对照组有显著性意义(P<0.01);重度窒息组与轻度窒息组之间CK、CK-MB、LDH和α-HBDH亦有显著性意义(P均<0.01);(2)24小时内重度窒息组与轻度窒息组CK-MB升高最为明显;生后第3天,CK和LDH、α-HBDH逐渐达高峰;第7d轻度窒息组CK、CK。MB、α-HBDH呈下降趋势,逐渐降至正常水平,而LDH仍呈升高水平,与对照组比较有显著差异(P<0.05);结论(1)新生儿窒息早期即有心肌酶的改变,表现缺氧程度与心肌酶水平升高呈正相关;(2)缺氧性心肌损害与新生儿窒息程度有相关性;(3)心肌酶谱检测对进一步诊断新生儿窒息后心肌损害有重要价值;(4)新生儿窒息应在及时复苏治疗同时进行心肌保护治疗。
Objective To observe the changes of myocardial enzymes in neonatal hypoxic myocardial injury after asphyxia and its clinical significance. Methods 40 newborns with asphyxia were selected and divided into 2 groups according to degree of asphyxia. The levels of creatine kinase (CK), creatine kinase (CK-MB ), Lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), and 20 non-hypoxic neonates were hospitalized in the same period as the control group for comparative analysis. Results (1) The levels of CK, CK-MB, LDH and α-HBDH in the mild asphyxia group and the severe asphyxia group were significantly higher than those in the control group (P <0.01). CK, CK-MB, LDH and α-HBDH in severe asphyxia group and mild asphyxia group were also significant (all P <0.01). (2) In 24 hours, severe asphyxia group and mild asphyxia group The most obvious increase of CK-MB was found in group A. CK and LDH, α-HBDH gradually reached the peak on the 3rd day after birth, CK and CK on the 7th day in mild asphyxia group. MB, α-HBDH showed a downward trend, gradually decreased to normal levels, and LDH was still elevated, compared with the control group were significantly different (P <0.05); Conclusion (1) neonatal asphyxia early myocardial enzyme changes, (2) There is a correlation between hypoxic myocardial damage and degree of neonatal asphyxia; (3) The detection of myocardial enzymes has important value in further diagnosis of neonatal asphyxia myocardial damage; (4) Neonatal asphyxia should be promptly resuscitated and treated with myocardial protection.