急性脑出血患者P波离散度及心肌酶分析

Analysis of P-wave Dispersion and Myocardial Enzymes in Patients with Acute Intracerebral Hemorrhage

目的观察急性脑出血(acute intracerebral hemorrhage,AICH)患者的P波离散度(P-wave dispersion,P_(disp))和心肌酶学变化,探讨AICH所致心肌损害的特点。方法选取227例AICH患者,分别于发病24小时内和第7天行十二导同步心电图检查,测量P波最大时限(P_(max))和P波最短时限(P_(min))并计算P波离散度(P_(disp))值;根据入院时格拉斯哥评分将患者分为轻型(13～15分)、中型(9～12)、重型组(3～8)3组,比较3组患者入院24小时内血清乳酸脱氢酶(lactate dehydrogenase,LDH)、α-羟丁酸脱氢酶(alPha-hydroxybutyrate dehydrogenase,α-HBDH)、肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶(MB isoenzyme of creatine kinase,CK-MB)的数值。结果 AICH患者24 h和7 d的P_(min)无明显差异(P=0.710);24 h P_(max)大于7 d(P=0.002);24 h P_(disp)大于7 d(P=0.006)。AICH患者24 h P_(max)>110 ms检出阳性数(19.8%)多于7 d(5.7%)(P<0.01);24 h P_(disp)>40 ms检出阳性数(67.4%)多于7 d(58.1%)(P=0.041);心肌酶检查,轻、中、重型3组之间差异有统计学意义(P<0.01),其中重型组患者的CK、CK-MB、LDH、α-HBDH均明显高于中型和轻型组(P均<0.01),中型组患者的以上4个心肌酶指标也高于轻型组(P均<0.01)。结论 AICH患者存在不同程度的心肌损伤,且与患者病情严重程度密切相关。

Objective To observe the change of P-wave dispersion （Pdisp） and myocardial enzymes in the patients with acute intracerebral hemorrhage （AICH）, and to explore the characteristics of myocardial damage. Methods Two-hundred and twenty-seven AICH patients were enrolled. The electrocardiogram was examined within 24-hour （24h） and on the seventh day （7d） after admission. The maximum P-wave timing （Pmax） and minimum P-wave timing （Pmin） were measured, and the Pdisp was calculated. The patients were divided into three groups according to the Glasgow scale, including the mild （13-15 scores）, moderate （9-12 scores） and severe group （3-8 scores）. The blood myocardial enzymes, including lactate dehydrogenase （LDH）, alpha-hydroxybutyrate dehydrogenase （α-HBDH）, creatine kinase （CK）, and MB isoenzyme of creatine kinase （CK-MB） were examined within 24h and compared among the three groups. Results The Pmin within 24h had no difference with that on the 7d （P=0.710）. However, the AICH patients showed significantly more prolonged Pmax （P=0.002） and Pdisp （P=0.006） within 24h than that on the 7d. The positive number of Pmax more than 110ms was significantly higher within 24h （19.8%） than that on the 7d （5.7%, P〈0.01）. Similarly, the positive number of Pdisp more than 40ms was also higher within 24h （67.4%） than that on the 7d （58.1%, P=0.041）. It showed marked differences in myocardial enzymes among the three groups （P〈0.01）. CK, CK-MB, LDH and α-HBDH in severe group were obviously higher than that of moderate and mild groups （P〈0.01）. The cardiac enzymes in moderate group were also higher than that of mild group （P〈0.01）.Conclusion The myocardial damage existed in AICH patients with different degrees; it was closely related to the severe degree of the AICH.