轻度窒息新生儿动态心电图及心肌酶变化的临床研究

Clinical study of changes of ambulatory electrocardiogram and myocardial enzyme in neonates with mild asphyxia

目的 探讨轻度窒息新生儿动态心电图（AECG）、心肌酶变化特点及其临床意义.方法 选取2011年6月至2013年8月我院新生儿科收治的轻度窒息新生儿为窒息组,同期选择本院分娩的30例健康新生儿为对照组,均于生后24h内行AECG检查,于出生18 ～24 h内抽取静脉血测定血清肌酸磷酸激酶（CK）、血清肌酸磷酸激酶同工酶（CK-MB）、血清乳酸脱氢酶（LDH）、血清谷草转氨酶（AST）、心肌肌钙蛋白（cTnI）.结果 窒息组（46例）与对照组（30例）新生儿AECG窦性心律指标（最慢心率、最快心率、平均心率）差异均无统计学意义（P＞0.05）;窒息组ST段改变及心律失常等其他几项综合指标（包括房早、房速、室早、Q-T间期延长、交界性逸搏）异常发生率高于对照组（65.2％比16.7％,89.1％比13.3％,P均＜0.01）.窒息组心肌酶指标及cTnI值均高于对照组[CK（604.7±275.4）比（162.0±95.1）,CK-MB（87.9±61.0）比（28.3±27.1）,LDH（686.0±383.5）比（310.7±133.5）,AST （95.0±63.1）比（35.2±13.9）,cTnI（0.12±0.11）比（0.02±0.01）,P均＜0.01].窒息组CK、CK-MB、LDH、AST异常发生率高于对照组（63.0％比16.7％,82.6％比6.7％,95.7％比20.0％,32.6％比6.7％,P均＜0.01）.结论 轻度窒息新生儿AECG监测可发现各种心律失常、ST段改变,其心肌酶亦明显高于正常新生儿,ST段改变及CK-MB的升高是诊断轻度窒息新生儿心肌损伤的可靠依据.

Objective To investigate the alteration of the ambulatory electrocardiogram （AECG） and myocardial enzyme in neonates with mild asphyxia and their clinical significance.Methods Total of 46 neonates with mild asphyxia admitted to our hospital from June 2011 to August 2013 were assigned to asphyxia group,and 30 healthy newborns to control group.AECG were performed within 24 hours after birth,and the serum concentrations of creatine kinase （CK）,creatine kinase MB （CK-MB）,aspartame aminotransferase （AST）,lactate dehydrogenase （LDH） and cardiac troponin Ⅰ （cTnI）） were tested mmediately after birth or within 18-24 hours after hospitalization.Results No statistically significant differences existed in neonatal AECG sinus rhythm indexes （including average heart rate,the fastest and slowest heart rates） between asphyxia group and control group （P 〉 0.05）.The incidences of ST change and arrhythmia （atrial premature,atrial tachycardia,ventricular premature,prolongation of the Q-T interval,junctional escape beats） were higher in asphyxia group than control group （65.2% vs.16.7%,89.1% vs.13.3%,both （P〈0.01）.The concentrations of myocardial enzymes and cardiac troponin were elevated in asphyxia group comparing with control group [CK （604.7 ±275.4） vs.（162±95.1）; CK-MB （87.9±61） vs.（28.3±27.1）; LDH （686±383.5） vs.（310.7±133.5）; AST（95±63.1） vs.（35.2±13.9）; cTnI （0.12±0.11） vs.（0.02±0.01）,all P〈0.01].The incidence of abnormal myocardial enzymes （CK,CK-MB,LDH and AST） in asphyxia group was higher than the control group （CK 63% vs.16.7% ; CK-MB 82.6% vs.6.7% ; LDH 95.7% vs.20% ; AST 32.6% vs.6.7%,all P 〈 0.01）.Conclusions Multiple types of arrhythmia and ST change were detected on AECG monitoring in neonates with mild asphyxia.The myocardial enzymes were also significantly higher in asphyxia group than healthy newborns.ST change and increased CK-MB may be reliable markers for myocardial injury in neonates with mild asphyxia.