常规心肌酶谱标记物在钝性胸部创伤后心肌挫伤的早期诊断价值

Early value of the conventional markers CK and CK-MB in the patients with myocardial contusion after blunt chest trauma

目的 探讨常规心肌酶谱标记物在钝性胸部创伤合并心肌挫伤早期的临床价值。方法 回顾性将钝性胸部创伤患者 14 2例依据心肌挫伤临床诊断标准分为钝性心肌挫伤组 (Ⅰ组 )和非钝性心肌挫伤组 (Ⅱ组 ) ,对入选病例 3d内心电图、超声心动图及创伤后 4 8h内心肌酶结果进行分析。结果 ①钝性心肌挫伤 4 9例 ,占总病例数的 34 5 % ;②心肌挫伤以较高的创伤评分、胸部多部位损伤、肋骨骨折 (木连枷胸 )发生率高、心电图及超声心动图异常表现多为特点 ,组间比较差异显著 ;③CK≥ 10 0 0IU/L或CK -MB≥ 4 0IU/L是较理想检测指标 ,两者联合诊断可提高敏感性。结论 采用心肌酶谱联合指标早期诊断心肌挫伤可提高诊断的敏感性 ,结合病史、心电图。

Objective To determine the early value of the conventional markers CK and CK-MB in the patients with myocardial contusion after blunt chest trauma.Methods According to clinic diagnostic criteria 142 patients with blunt chest trauma were enrolled in this retrospective study and divided into two groups: myocardial contusion (Ⅰ group)and no myocardial contusion (Ⅱ group).The analysis of electrocardiogram and echocardiography within 3 days and serum levels of CK,CK-MB activities within 48 hours were performed.Results Myocardial contusion was diagnosed in 49 of 142 patients (34.5%)with acute blunt chest trauma;Patients with myocardial contusion had a significantly higher Injury Severity Score,multiple position injury,rib fracture especial flail chest and abnormal electrocardiogram and echocardiography were significantly different with no myocardial contusion group;CK activity≥1 000 IU/L or CK-MB activity≥40 IU/L were the more ideal target in specificity and sensitivity, combining CK activity≥1 000 IU/L with CK-MB activity ≥40 IU/L can improve the sensitivity.Conclusion Adopting the joint target of the conventional markers can improve diagnostic sensitivity of myocardial contusion and the history of thoracic trauma,electrocardiogram and echocardiography were beneficial to diagnostic accuracy.