创伤患者肌酸激酶的动态变化及临床意义

Dynamic changes and clinical significance of creatine kinase in traumatic patients

目的观察创伤患者血清肌酸激酶（CK）及其同功酶（CK-MM）的动态变化,探讨其临床意义。方法总结6年来我院收治的854例创伤患者的临床资料,观察第1、2、3、4、5、6～7、8～9、10～11、12～13、14～15天血清CK变化。采用创伤严重程度（ISS）评分,将其分为≤15分组、16～25分组、26～35分组、≥36分组,比较各组血清CK差异,对照组为外科平诊患者;并比较存活组与死亡组患者的血清CK变化。结果各个创伤组在伤后第1天开始血清CK就明显高于对照组（t=3.308～8.254,P〈0.01）,ISS评分越高,CK增高越明显,组间差异有统计学意义（F=9.162,P〈0.01）;伤后1～2d,各个创伤组血清CK迅速达到峰值,之后逐渐下降,随着ISS评分越高,CK保持高水平的时间越长、下降越缓慢,各个时间段之间的差异有统计学意义（F=5.719,P〈0.01）。成活组与死亡组的血清CK均增高,第8～9天时,成活组的CK值恢复正常,死亡组CK保持高水平时间更长,直到第14～15天也未恢复正常,组间差异有统计学意义（t=3.889,P〈0.01）。结论血清CK可作为评价全身软组织损伤严重程度的一项重要指标，对判断伤情及预后有重要意义。

Objective To investigate the clinical significance of serum creatine kinase（CK） and its isoenyme （ CK-MM ） through observing their dynamic change. Methods Clinical data of 854 traumatic patients in the past six years were retrospectively analyzed, and the serum changes of CK were recorded at 1,2,3,4,5,6 ~ 7,8 ~ 9, 10 -11,12 ~ 13,14 ~ 15 day. According to injury severity score （ISS） , all cases were divided into ≤15,16 -25, 26 - 35, 〉136 group to compare with their serum levels of CK. The control group was composed of common surgical patients. Serum CK levels in survival group were compared with that in dead group. Results Serum CK levels in all traumatic groups were significantly more than that of control group from 1st day after injury （ t = 3. 308 - 8. 254, P 〈 0.01 ）. The higher ISS was, the more its CK increased. There was statistical significance in differences of serum CK among traumatic groups （ F =9. 162 ,P 〈 0.01 ）. The serum levels of CK in traumatic groups speedly increased to the summit at 1 to 2 day after injury, and then they decreased gradually. The higher ISS was, the slower its CK decreased, and the longer its high level of CK remained. The differenc of CK in serum among all time intervals had statistical significance（ F = 5. 719 ,P 〈 0.01 ）. CK rised significantly in survival and dead group after injury. The survival CK recovered normally at 8th - 9th day, but the dead CK still remained at the higher level and longer time until 14th- 15th day. The differenc of CK in serum between the two groups had statistical significance（ t = 3. 889, P 〈 0.01 ）. Conclusion Serum CK value has important significance for determining condition and prognosis of trauma because it can be regarded as an index to evaluate severity of soft tissue trauma.