电击伤致心脏损害患者心肌酶、心电图的变化及其临床意义

Changes of myocardial enzymes and ECGs in patients with heart damage caused by electric injury and its clinical significance

目的研究电击伤致心脏损害后患者的心肌酶、心电图改变。方法35例电击伤患者。其中男性30例．女性5例：年龄15．53岁，平均年龄35．2岁。根据有无心电图异常分为心电图异常组（A组23例，其中男性20例，女性3例：年龄16．53岁，平均年龄36.2岁）、心电图正常组（B组12例，其中男性10例，女性2例，年龄15～52岁，平均年龄34.2岁）。正常组（C组10例，其中男性8例，女性2例，年龄15．53岁。平均年龄35．2岁）。高电压（1000V）伤23例，低电压（220～380V）伤12例。检查心电图变化，行实验室检查和TNT检查,检测血清肌酸激酶（CK）和肌酸激酶同工酶（CK-MB）活性。结果A组23例患者心电图异常．B组12例患者心电图基本正常：心电图异常患者主要表现为T波高耸和T波高耸伴心房纤颤。高电压组心电图异常的发生率为83．3％（19／23），低电压组心电图异常的发生率33.3％（4／12）；两组比较，差异有统计学意义（P〈0．05）。A组CK、CK—MB均高于B组[（4223．7±1116．4）U／Lws（294．5±21．7）U／L，（586．9±96．9）U／LUS（123．7±5．3）U／L；P〈0．05]：A、B组明显高于C组[（160．4±26．1）U／L、（20．5±3．1）U／L]。结论心脏损害是电击伤的常见并发症，高压电更易致心脏损害．血清CK、CK—MB可用于临床评价电击伤患者的心脏损害。

Objective To study myocardial enzymes and electrocardiogram（ECG） changes of patients with electrically injury- induced heart damage. Methods A total of 35 patients with electrically injury-induced were enrolled, which included 30 males and 5 females, aged 15 - 53 years old with mean age of 35.2. Based on whether they have ECG abnormal or not, all of them were divided into 2 groups, abnormal ECG group（ group A, n = 23, 20 males and 3 females, aged 15 - 53 years old, with mean age of 36.2） and normal ECG group （group B, n = 12, 10 males and 2 females, aged 15 - 53 years old, with mean age of 34.2 ）, the high- vohage（1 000 V） injury were 23 cases and low-voltage（220 - 380 V） injury were 12 cases. Ten cases in normal control group （group C, n = 10, 8 males and 2 females, aged 15 - 53 years old, with mean age of 35.2）. The ECG changes, laboratory examination and check with the TNT, detection of serum creatine kinase（CK） and creatine kinase isoenzyme（CK-MB） activity were performed. Results The 23 patients in group A had abnormal ECG, and 10 cases in group B patients had normal ECG. The abnormal patients were mainly showed T-wave towering and T-wave towering combining with atrial fibrillation. The CK, CK - MB in group A were higher than that of group B[（4 223.7 ± 1 116.4） U/L vs （294.5 ± 21.7） U/L, （586.9 ± 96.9） U/L vs （123.7 ± 5.3） U/L; P 〈 0.05]. Conclusion It is demonstrated that cardiac damage is the common complication of electrical damaging, high-voltage are more likely to cause heart damage, serum CK, CK - MB could be used in the clinical evaluation of patients with electric injury-induced heart damage.