重度窒息新生儿横纹肌损伤及溶解的研究

THE STUDY OF STRIATED MUSCLE INJURY AND RHABDOMYOLYSIS IN SE- VERE ASPHYXIATED NEONATES

研究重度窒息新生儿横纹肌损伤及溶解发生情况、影响因素及对机体的影响,采用多元逐步回归等方法,以69例足月重度窒息新生儿为研究对象,研究生后0-48h(Ⅰ)、5～7天(Ⅱ)肌酸激酶(CK)的动态变化、影响因素及其对其他生化指标-尿素(UREA)、血钙(Ca)。血磷(P)、血钾(K)和血尿酸(UA)的影响,并对其中10例同期进行血清肌红蛋白检测,分析CK与肌红蛋白间关系。结果显示:①按诊断标准,采用不同正常参考值,重度窒息新生儿横纹肌溶解发生率21.7％～51.7％;②在重度窒息基础上,合并宫内窘迫及经产道出生者CK-I水平较高;③CK-I水平影响Ca-I水平,CK-I越高,Ca-I越低;④重度窒息新生儿肌红蛋白明显高于正常新生儿脐血肌红蛋白(361.8±202.3)ng/ml vs(35.8±11.7)ng/ml,(t=5.263,P<0.001);随着病情的恢复,窒息后CK及肌红蛋白水平均有较显著的下降(P:0.022,P=0.001),生后早期肌红蛋白水平高的病例,其CK恢复较慢(r=0.819,P=0.013)。结论:可以认为重度窒息新生儿中存在横纹肌溶解,其尤易发生于合并宫内窘迫、经产道出生者;横纹肌损伤和溶解影响生化代谢,未发现其有加重窒息后肾脏损伤的作用;随病情恢复,横纹肌损伤及溶解可逐渐恢复。

To investigate the incidence, affecting factors and effects of striated muscle injury and rhabdomyolys-is in severe asphyxiated neonates, 69 severe asphyxiated full - term neonates were studied. The level, dynamic change, influencing factors of creatine kinase(CK) in 0-48 h(Ⅰ) and 5-7 days(Ⅱ ) were studied, and the effects of CK - Ⅰ level on UREA, calcium(Ca), potassium(K) , phosphorus(P) and uric acid(UA) were analyzed. Concurrently, serum myoglobin measurements were performed prospective-ly on 10 asphyxiated neonates within 24 hours (myoglobin - Ⅰ) and 5-7 days (myoglobin -Ⅱ ) after birth, to determine its relationship with CK and their dynamic changes. Eleven umbilical cord blood samples were collected from vaginal delivered, full - term, non - distressed or asphyxiated infants to work as myoblobin control. Multiple regression analysis, t - test, and Pearson correlation test were used to analyze results. Results: (1) Using different reference values for CK, rhabdomyolysis was confirmed in 21.7% -51.7% of infants studied. (2) The level of CK - I was directly related to the method of delivery and the presence of absence of intrauterine distress. CK values were higher in neonates with intrauterine distress or delivered vaginally. (3)There was negative relation between CK -Ⅰ and Ca -Ⅰ. (4)Myoglobin increased significantly in severe asphyxiated infants than in control ((361.8±202.3) ng/ml vs (35.8±11.7) ng/ml, t = 5.263, P <0.001) . There was a significant decrease in both CK and myoglobin values as the conditions of infants improved ( P = 0.022, P = 0.001) . This study also revealed a relationship between CK - Ⅱ and myoglobin - Ⅰ, r = 0.819, P = 0.001, It meansd that a high myoglobin level is corelated with the prolonged recovery of CK. We concluded that Rhabdomyolysis occurs in severe asphyxiated neonates, especially in neonates with intrauterine distress and those delivered vaginally. This recovered as infants condition improved. Renal function was not found to be affected.