急性一氧化碳中毒致横纹肌损伤的临床分析

Striated muscular injury caused by acute carbon monoxide poisoning

目的探讨不同程度急性一氧化碳中毒(ACOP)致横纹肌损伤的发生情况以及心肌酶反应横纹肌损伤的临床意义。方法收集2014年10月~2015年2月吉林市中心医院收治的45例ACOP患者的临床资料,将ACOP患者分为轻度中毒、中度中毒、重度中毒组,根据有无横纹肌损伤的症状和体征(肿胀、疼痛或极度肌无力等)将患者分为显性肌损伤组与隐性肌损伤组,结合心肌酶(肌酸激酶、肌酸激酶同工酶、谷草转氨酶、乳酸脱氢酶)、心电图(ECG)、肌钙蛋白I(CTn I)测定结果进行临床分析。结果轻、中、重度中毒并发横纹肌损伤的发生率分别为11.1%、24.4%、24.4%,33.3%的ACOP患者并发显性肌损伤。ACOP会造成不同程度的心肌酶学改变,重度与轻、中度相比,差异有统计学意义(P<0.05),中毒程度越重,心肌酶改变越明显,重度中毒组的显性肌损伤发生率与轻度中毒组及中度中毒组的显性肌损伤发生率比较,差异无统计学意义(Z=0.22,P>0.05);显性肌损伤组与隐性肌损伤组相比,肌酸激酶(CK)差异有统计学意义(P<0.05),CK-MB%(CK-MB/CK)差异无统计学意义。结论中、重度ACOP致横纹肌损伤较为常见。显性肌损伤的发生率与中毒程度无关,与CK活力升高呈正相关,心肌酶的升高更大程度上提示横纹肌的损伤,在反映心肌损伤方面特异性不高。

Objective To investigate the incidence of rhabdomyolysis, and the role of elevated serum myocardial en- zyme played in acute carbon monoxide poisoning（ACOP）. Methods 45 patients with ACOP from October 2014 to Febru- ary 2015 were analyzed retrospectively. The patients were divided into three groups：mild poisoning（ 18 patients） , moderate poisoning（ 16 patients）, severe poisoning（ 11 patients） ,in addition, according to the clinical manifestations of striated mus- cular injury（ swelling,pain or serious myasthenia）, the patients were divided into two groups：the evident injury group and nonevident injury group. Results The rates of striated muscular injury werell. 1% ,24.4% ,24.4% in mild,moderate, severe poisoning. The rate of the evident injury patients was 33.3% in ACOP. There was a positive correlation between se- vere poisoning and mild/moderate poisoning（P 〈 0.05 ） ,the severer poisoning,the more obvious changes of serum myocar- dial enzymes, There was no significant difference in the incidence of positive muscular injury symptoms among three groups （Z = 0.22 ,P 〉 0.05 ）, there was significant difference in the ereatine kinase （CK）between the evident injury group and nonevident injury group（ P 〈 0.05 ）, however, there was no significant difference in CK-MB% （CK-MB/CK）. Conclusion Striated muscular injury is not a rare complication of ACOP, mainly in moderate and severe poisoning. The elevation of serum myocardial enzymes and the degree of poisoning were unrelated with the incidence of positive muscular injury symp- toms. The strikingly elevated serum level of serum myocardial enzyme in patients with ACOP might be more likely to indi- cate the striated muscle but not myocardiac injury.