自发性蛛网膜下腔出血患者心电图及心肌酶谱改变与预后的相关性研究

Changes of electrocardiogram and myocardial enzyme in patients with SAH correlation between prognosis and analysis

目的分析自发性蛛网膜下腔出血（SAH）患者心电图及心肌酶谱改变与预后的相关性。方法观察128例SAH患者心电图及血清肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）、乳酸脱氢酶（LDH）、谷草转氨酶（AST）的变化，于发病3日内开始检测，其后跟踪检测至病愈。对照组观察同一时间心电图及心肌酶谱的变化。按GOS评分评价SAH患者的预后。结果SAH患者心电图改变及心肌酶谱变化情况与对照组比较差异有统计学意义（P〈0．01）。在心电图表现正常的SAH患者中仍有部分患者有心肌酶谱明显升高，有意识障碍的患者心肌酶谱的升高及心电图的缺血性变化与无意识障碍的患者比较差异有统计学意义（P〈0．01）。在18例心电图和心肌酶谱1项异常患者死亡2例（11．1％），47例2项异常患者死亡17例（36．2％），29例3项异常患者死亡23例（79．3％），而34例检查正常者死亡2例（5．9％）。结论SAH引起的心脏损害在病情严重的患者，心电图改变及心肌酶谱变化较大，但二者的变化存在不一致性，这对指导治疗及预后有重要的临床意义。

Objective To analyze the spontaneous subarachnoid hemorrhage （SAH） in patients with ECG and myocardial enzymes change the prognosis. Methods 128 patients with spontaneous sub- aracbnoid hemorrhage patients with ECG changes and serum creatine kinase（CK） isoenzyme（ CK-MB）, lactate dehydrogenase（LDH）, aspartate aminotransferase（AST） change case, onset within three days of detection, tracking and detection to later recovered. The control group of normal ECG changes and myocar- dial enzymes changes observed at the same time. By GOS score evaluation prognosis of patients with SAH. Results SAH patients with ECG changes and myocardial enzymes changes with normal controls signifi- cant difference （ P 〈 0.01 ）. In normal ECG SAH patients, some patients are still significantly higher myo- cardial enzymes, and severe illness disturbance of consciousness in patients with elevated cardiac enzymes and ECG ischemic changes and unconscious obstacles patients significant difference （ P 〈 0.01 ）. An ex- ception in the 18 cases ECG and myocardial enzymes ,2 deaths （11.1% ） ,47 patients with two abnormal in 17 patients died（36.2% ） ,29 cases of abnormal death in 23 cases（79.3% ） ,2 deaths（5.9% ） and 34 cases of normal, abnormal ECG and myocardial enzymes extent the heavier, higher mortality, the GOS poor prognosis. Conclusion Patients with spontaneous subaraehnoid hemorrhage caused by heart damage in the more severe the disease, ECG changes and myocardial enzymes change the greater, but the changes there is inconsistency, treatment guidance and prognosis play an important role.