早期诊断骨筋膜室综合征中动态监测CK和AST的应用

The Application of Phosphocreatine Kinase and Aspartate Aminotransferase in Early Diagnosis of Compartment Syndrome

目的连续、动态检测一系列生化指标,并探讨其在骨筋膜室综合征早期诊断及病情评估中的作用。方法收集2005年4月至2008年7月入院的四肢骨筋膜室综合症的患者共40例,使用日本Olympus自动生化分析仪在患者受伤入院后2、24h以及1、2、3、4周连续、动态检测血浆磷酸肌酸激酶(creatine kinase,CK)、谷草转氨酶(aspartate aminotransferase,AST)浓度。在手术中以及术后1、2、3周取患肢受累肌肉组织行病理检查。结果患者受伤2h后,血浆中CK、AST浓度即急剧升高,分别为正常值的20和6倍。24h后各项指标达到峰值或谷值,CK和AST分别达正常值的42、10倍。1周后,AST与正常值比较仍有显著性差异(P<0.01)。病理检查显示肌肉标本明显坏死,呈不可逆性变化。结论相关生化指标的变化能客观反映病情的严重程度。当这些指标急剧升高时要高度警惕骨筋膜室综合征的发生。动态、连续监测这些指标能为早期诊断及评估骨筋膜室综合征病情提供帮助。

Objective In order to determine the efficacy of several biochemical indicators in the early diagnosis of compartment syndrome. Methods Collected 40 cases from 2005-2008,monitoring CK and AST continuously and dynamically after injury 2 、 24 hours, 1,2 、 3 and 4 weeks later ,The concentration of CK and AST were measured by using Japanese Olympus automatic biochemistry analysator. The muscle preparations from affected extremity were taken after operation and 1,2,3 weeks later for biopsy. Results Two hours later after injury,the contents of CK and AST increased sharply. The contents of CK and AST were about 20 and 6 times more than the nomal. 24 hours later,the contents of CK and AST reached its maximum,the contents of CK and AST were about 42 and 10 times more than the normal. Pathological changes of muscle were irreversible. Conclusion The change of the contents of CK and AST can reflect the progression of disease objectively. If it increased sharply ,the chance of compartment syndrome was high. Monitoring it dynamicly and continuously can provide assistant for early diagnosis of compartment syndrome and evaluating pathogenetic condition.