血气分析及肌酸激酶同工酶在判断新生儿窒息后心肌损伤中的意义

Significance of arterial blood gas analysis and creatine kinase isoenzyme in determining myocardial injury after neonatal asphyxia

目的探讨血气分析及肌酸激酶同工酶(CK-MB)在判断新生儿窒息后心肌损伤中的意义。方法选取杭州市临安区第一人民医院2019年1月至2020年12月收治的30例符合新生儿窒息诊断标准的患儿和15例健康的新生儿(无窒息组)为研究对象,其中窒息新生儿根据1 min Apgar评分分为轻度窒息组和重度窒息组,每组15例。观察并比较不同程度窒息新生儿出生后心肌损伤情况、血气分析结果[包括酸碱度(pH)、剩余碱(BE)、乳酸(LAC)]、心肌酶谱检测结果[包括肌酸激酶(CK)、CK-MB、α-羟丁酸脱氢酶(α-HBDH)、乳酸脱氢酶(LDH)]和随访情况。结果不同程度窒息新生儿出生后发生心肌损伤的比例比较差异有统计学意义(均P<0.05),窒息程度越重则发生心肌损伤的比例越高。无论是脐血还是出生后1 h的血气分析结果,不同程度窒息新生儿比较差异均有统计学意义(均P<0.05);pH及BE越小、LAC越大,提示新生儿窒息程度越重。不同程度窒息新生儿出生后1 h血清CK-MB比较差异有统计学意义(P<0.05),CK-MB越高,提示新生儿窒息程度越重;不同程度窒息新生儿出生后1 h血清CK、α-HDBD、LDH以及出生后第7天CK、CK-MB、α-HDBD、LDH比较,差异均无统计学意义(均P>0.05)。为期1年的随访结果显示,无窒息组、轻度窒息组新生儿均健康存活,无明显神经系统后遗症;重度窒息组有1例新生儿出现脑发育落后。结论血气分析指标(pH、BE、LAC)和CK-MB能早期反映新生儿窒息程度,有助于窒息后心肌损伤的判断,值得在临床推广应用。

Objective To investigate the significance of arterial blood gas analysis and creatine kinase isoenzyme(CK-MB) in determining myocardial injury a fter neonatal asphyxia.Methods A total of 30 neonates meet with asphyxia diagnostic criteria and 15 healthy neonates(non-asphyxia group) admitted to the First People’s Ho s p ital of Lin ’an District,Hangzhou from January 2019 to December 2020 were selected.Neonates with asphyxia were divided into mild and severe asphyxia groups according to the 1 minute Apgar score,with 15 cases rn each group.To observe and compare the different degree of myocardial injury of the neonates after,arterial blood gas analysis results(including pH,base excess(BE),lactic acid(LAC)],myocardial enzyme spectrum [including creatine kinase(CK),creatine kinase isoenzyme(CK-MB) and α-hydro xybutyrate dehydrogenase(α-HBDH),lactate dehydrogenase(LDH)] and follow-up.Results There was a statistically significant difference in the proportion of myocardial injury in neonates with different degrees of asphyxia after birth(all P<0.05).The more severe the degree of asphyxia,the higher the proportion of myocardial injury.Both umbilical cord blood and arterial blood gas analysis results at 1 h after birth showed significant differences among neonates with different degrees of asphyxia(all P<0.05).The smaller the pH and BE,the larger the LAC,the more severe the degree of neonatal asphyxia.There was a significant diffe rence in serum CK-MB of neonates with diffe rent degrees of asphyxia 1 hour after birth(P<0.05).The higher the CK-MB,the more severe the degree of asphyxia.There was no significant difference in serum CK,CK-MB,α-HDBD and LDH among neonates with different degrees of asphyxia 1 h or 7 days after birth(all P>0.05).One-year follow-up showed that all the neonates in the groups without or with mild asphyxia survived without significant neurological sequelae.One neonate had neurological retardation in the severe asphyxia group.Conclusion Arterial blood gas analysis indexes(pH,BE,LAC) and CK-MB can reflect the degree of neonatal asphyxia in early stage,which is helpful for determining myocardial injury after asphyxia,and is worthy of clinical application.