体外电复律对恶性心律失常患者心肌酶谱及肌钙蛋白I的影响

The changes of Cardiac troponin I and cardiac enzymes after external cardioversion of malignant arrhythmia

目的探讨临床体外电复律对恶性心律失常患者心肌酶谱及肌钙蛋白I的影响。方法院前及院内恶性心律失常患者，排除胸廓及心脏外伤患者以及既往心梗患者，经体外电复律成功后，根据冠脉造影和电复律成功后心电图表现分为非急性心梗组和急性心梗组。分析体外电复律对两组电复律前或即刻和12h血清CK、CK—MB、cTnI的影响。结果非急性心梗组及急性心梗组分别有22例和30例患者，两组电复律累积次数及能量差异无统计学意义[（3．0±1．2）次比（3．0±1．3）次；（446±275）J比（450±293）J，P〉0．05]；体外电复律前或即刻及12h，非急性心梗组与急性心梗组相比，CK12[（452．3±204．2）U／L比（562．2±234．1）U／L]、CK—MB0[（10．6±7．5）U／L比[27．1±12．3）U／LJ、CK—MB12[（30．0±20．5）U／L比（180．5±62．3）U／L]、cTnI0[（0．04±0．04）ng／ml比（0．58±0．86）ng／ml]、cTnI12[（0．06＋0．04）ng／ml比（17．47±12．07）ng／ml]差异有统计学意义（P〈0．01），除外CK0[（129．2±90．5）U／L比（135．3±94．8）U／L，P〉0．05]。体外电复律后12h较电复律前或即刻CK、CK—MB、cTnI均显著升高（P〈0．05或P〈0．01）。CK—MB0、CK—MB12、cTn10、cTnI12阳性率，非急性心梗组分别为9．1％、54．5％、0、0，急性心梗组分别为53．3％、90．0％、20．0％、93．3％。结论体外电复律可导致恶性心律失常患者CK、CK—MB、eTnI升高，但eTnI升高程度并不影响急性心梗的诊断。

Objective To study the changes of Cardiac Troponin I and cardiac enzymes after external cardioversion （ECV） in patients with malignant arrhythmia. Methods The patients with malignant arrhythmia in pre-hospital and in-hospital were divided into acute myocardial infarction （AMI） group and no-AMI group according to coronary arteriongraphy and electrocardiogram after ECV. Patients were excluded if they had bony thorax trauma or eardiotrauma or had had a myocardial infarction. The levels of serum total creatine kinase （CK）, CK-MB isoenzyme （CK-MB） and cTnI were measured before or immediately and 12h after ECV. Results AMI group and no-AMl group had 30 and 22 cases respectively. The total energy and numbers of ECV in two groups has no difference [ （3.0±1.2）J vs （3.0±1.3）J, （446±275）J vs （450±293）J,P〉0.05 ]. The level of CK12[ （452.3±204.2 ）U/L vs （ 562.2±234.1 ）U/L ], CK-MB0[ （ 10.6±7.5 ）U/L vs （27.1 ± 12.3 ）U/L 1, CK-MB12 [ （ 30.0±20.5 ）U/L vs （ 180.5±62.3 ）U/L 1, cTnI [ （0.04±0.04）ng/ml vs （0.58_＋0.86）ug/ml ] and cTnI12[ （0.06±0.04）ng/ml vs（ 17.47± 12.07）ng/ml] has no significantly difference in two groups （P〈0.01）,except for CK0 [（129.2±90.5）U/L vs （135.3±94.8）U/L, P〉0.05],CK,CK-MB and cTnI were higher at 12 h after ECV than before or immediately after ECV in two groups （P〈0.05 or P〈0.01）. The positive ratio of CK-MB0, CK-MB12, eTnI0 and cTnI12 was 9.1%,54.5%,0 and 0 in no-AMl group respectively, wherease the ration was 53.3%,90.0%,20.0%,and 93.3% in AMI group respectively. Conclusion ECV in patients with malignant arrhythmia may elevate the level of CK, CK-MB and cTnI, but the elevation of cTnI don＇t influence the diagnosis of AMI.