新生儿缺氧缺血性脑病伴心肌损害的临床分析

Clinical analysis of neonatal hypoxic-ischemic encephalopathy with myocardial injury

目的探讨新生儿缺氧缺血性脑病(NHIE)伴心肌损害的心电图、血清心肌酶学改变与HIE分度的相互关系。方法对59例HIE伴心肌损害的患儿出生后48h以内的血清LDH(乳酸脱氢酶)、CK(肌酸激酶)、CK-MB(肌酸激酶同功酶)、HBDH(a-羟丁酸脱氢酶)的含量进行测定,并作心电图检查。结果43例(43/59)患儿心电图出现改变,重度组改变分别大于轻、中度组,轻度组大于中度组。经方差分析显示:心肌酶中CK、CK-MB变化与HIE的分度呈正相关性,差异显著(P<0.05);Q检验分析显示:轻度与重度间心肌酶变化也呈正相关性,差异显著(P<0.05),轻度与中度、中度和重度间无显著差异;T检验分析却显示:轻度组与中、重度组间心肌酶中CK-MB变化呈极显著性差异,P<0.01(t=2.741,P=0.008),而轻、中度组与重度组间无差异。12例(12/59)病人于出生后12h内出现心肌酶谱变化,而其中8例的酶谱变化出现于生后6h内。结论常规检测心肌酶、心电图对HIE伴心肌损害的程度及预后判断,以及指导临床治疗有较大参考价值;生后12小时内即可监测心肌酶学变化。

Objective To evaluate the relationship of electrocardiogram and myocardial enzymogram with the degrees of hypoxic-ischemic encephalopa-thy(HIE).Methods Electrocardiograms were ex-amined and serum lactic dehydregenase(LDH)?crea-tine kinase (CK)?CK-MB?hydroxybutyric dehydrege-nase(HBDH)were measured in59children of HIEwith myocardial injury within first48hours of life.Results43cases (43/59,72.9%)in59patients had changes of electrocardiogram and the changes were more significant in the severe group of HIE with myocardial injury than those in the moderate or mild ones,but these changes in the mild one were more significant than those in the moderate one.The value of CK、CK-MB of myocardioenzy-mogram was positively related to the degrees of the HIE,P<0.05.The difference in changes of the enzymogram in the mild group of HIE compared with the severe one was significant (P<0.05),but the difference between mild group with moderate one and that between moderate group with sever one were all of no so in significant.There was signifi-cantly statistical difference in change of CK-MB of the enzymogram in mild group compared with those in moderate and severe ones(t=2.714;P=0.08,P<0.01),but with no difference in mild and moderate ones compared with severe one.There were12pa-tients in59children with changes of enzymogram within first12hours of life,and8cases(8/12,66.7%)within first6hours.Conclusion It is significantly valuable to carry out electrocardiogram and myocardial enzymogram routinely in determin-ing the degree、treatment and prognosis of HIE with myocardial injury and the enzymogram should be taken within first12hours of life.