重度颅脑外伤致心电图心肌酶谱改变的临床意义

Clinical Value of Changes of EKG and Myocardial Enzymogram after Severe Craniocerebral injury

检测58例严重颅脑外伤的心电图、心肌酶谱，发现81％（47／58）心电图异常与73％（43／58）心肌酶谱变化同时存在．心电图变化表现为各种心律失常，ST－T改变，Q－T延长，心肌酶语变化主要以谷革转氨酶（AST），肌酸磷酸激酶（CK）和同功酶（CK－MB）增高为主．增高范围为：AST160－1280u／L，CK420～3120u／L，CK-MB24～72u／L．酶谱的变化与Glascow计分标准是负相关，并与疾病的预后关系密切．其中死亡15例，心肌酶谱持续增高直至死亡，心电图表现为Q－T延长、室早、ST－T改变．生存43例，两者的变化随病情而演变，病情严重心电图表现心肌损害、心律失常严重，心肌酶谱持续升高；病情好转，两者趋向正常．因此，作者认为严重颅脑外伤的心电图改变和心肌酶谱的变化可作为判断病情，预后和治疗效果的一个重要指标．

Study of EKG and myocardial enzymogram(ME) of 58 cases of severe craniocerebralinjury showed 81% (47/18) EKG abnormalities and 73% (43/58) ME changes. EKG changes showed various arrhythrnia, ST-T changes and Q-T prolongation. The elevation of AST, CK-MB were the princioal changes of ME, whose elevation rangers respectively were AST 160~1280u/L, CK 420~3120u/L, CK-MB 24~72u/L. ME changes showed negative correlation to Glascow Coma Scale(GOS) and close relation to prognosis in 15 dead cases ME had constant elevation till death. EKG displayed Q-T prolongation,VPB ventricular tachycardia and ST-T changes. In 43 survived cases, EKG and ME changed along with the patient's conditions. When the patient is in critical condition, his EKG shows myocardial impair. severe arrhythmia and constant elevation of ME. When his condition improves, EKG and ME trend to normal. It proves that both EKG and ME have positive correlation to craniocerebral injury. So EKG and ME are good parameters for judgement o the patient's condition prognosis and therapeutic effect in patients with craniocerebral iujury