电烧伤患者血清肌酸磷酸激酶变化的临床意义

Clinical significance of the change of serum CK-MM in electrical injured patients

目的 探讨血清肌酸磷酸激酶 (craetinephosphokinase ,CK)同工酶 (CK MM )的变化对电烧伤患者肌肉感染、坏死的诊断价值。 方法 高压电击伤与电弧烧伤各 17例分为A、B两组。A组为手术证实有明显的肌肉坏死者 ,B组为手术证实无肌肉坏死者。分别监测患者伤后、术前及术后血清CK MM的浓度 ,同期进行血、尿常规 ,肝、肾功能及创面细菌计数检查 ,并以 2 0例正常人血清CK MM值为对照。结果 (1)A组伤后及扩创术后 1d血清CK MM的浓度显著升高 ,达正常对照组的 6倍 ;术后 3d 15例降至正常 ,2例因创面感染CK MM仍维持较高水平 ,经再次扩创抗感染处理后降至正常。其变化与手术所见、外周血白细胞计数变化及创面细菌计数相一致。 (2 )B组植皮术前及术后CK MM值轻度升高。 结论 CK MM可作为电击伤肌肉感染、坏死的监测指标 ,具有较高的特异性和敏感性。

Objective To evaluate the diagnostic value of the changes in serum CK and its isozymes in the muscular infection and necrosis in electrical injured patients. Methods Seventeen patients were divided into A and B groups according to the causes, i.e. electrical injury as A and electrical arc flame burn as B groups. Obvious muscle necrosis was identified in A but not in B groups. The serum CK MM concentration was determined after injury, before and after the operations. Simultaneously, the blood and urine routine, the hepatic and renal function and wound bacterial counting were determined and compared with those in 20 healthy people. Results 1.The serum CK MM in A group increased evidently after injury and 1 day after wound debridement to the 6 times that in normal control. The enzyme decreased to normal at 3 post operative days in 15 cases and remained at relative high level in 2 cases due to the wound infection and lowered down to normal level after wound re debridement. 2. The serum CK MM in B group increased slightly before and after skin grafting. Conclusion CK MM could be employed as the index for the infection and necrosis of the muscle in electrical injured patients due to its high specificity and sensitivity. [