连续动态监测磷酸肌酸激酶(CK)在骨筋膜室综合征早期诊断中的作用

Application of monitoring phosphocreatine kinase continuously and dynamically in early diagnosis of compartment syndrome

目的:连续、动态检测磷酸肌酸激酶(CK)浓度,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:四肢骨筋膜室综合征患者40例,男34例,女6例,平均年龄(37.03±13.02)岁。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CK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浓度即急剧升高,为正常值的20倍。24h后各项指标达到峰值或谷值,CK达正常值的42倍。1周后,CK与正常值比较无统计学差异,病理显示肌肉标本明显坏死呈不可逆性变化。结论:CK浓度的变化能客观的反映病情严重程度。当这项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CK浓度能为早期诊断及评估骨筋膜室综合征病情提供帮助。

Objective：To determine the efficacy of phosphocreatine kinase in the early diagnosis of compartment syndrome. Methods ： Forty patients with compartment syndrome of limbs were reviewed from 2005 to 2008 including 34 males and 6 females with an average age of （37.03± 13.02） years. Monitoring phosphocreatine kinase continuously and dynamically after injured 2,24 hours, 1,2,3 and 4 weeks later. The concentration of CK 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 increased sharply and the contents of CK were about 20 times more than the nomal. Twenty-four hours later, the contents of CK reached its maximum, the contents of CK were about 42 times more than the nomal. One week later,the contents of CK recovered to normal level. Pathological changes of muscle were irreversible. Conclusion：The change of the contents of CK can reflect the progression of disease objectively. If it increased sharply, the chance of compartment syndrome was high. Monitored it dynamicly and continuously can provide assistant for early diagnosis of compartment syndrome and evaluating pathogenetic condition.