手术干预对高血压脑出血病人心肌损伤的影响  

Effects of operation intervention on myocardial damage in patients with hypertensive cerebral hemorrhage

作　　者：郑元回 周宗爱 章剑 郑金意 

机构地区：[1]苍南县人民医院神经外科,浙江温州325800

出　　处：《全科医学临床与教育》2009年第6期576-578,581,共4页Clinical Education of General Practice

基　　金：温州市科技计划项目(Y20080236)

摘　　要：目的探讨手术干预对高血压脑出血患者心肌损伤的影响。方法选择44例高血压脑出血患者,根据GCS评分及出血量,并结合临床和CT表现分为手术治疗组和非手术治疗组,对照组为同期健康体检者。入院24h内、3d、7d和15d抽晨血测定心肌酶谱和心电图检查并进行分析。结果高血压脑出血患者在发病后24h内血清心肌酶开始升高,3d达到高峰,以后逐渐下降;心电图异常发生率分别为65.91%、88.64%、50.55%和34.09%。高血压脑出血患者术后7d和15d心电图异常发生率低于非手术组,但两组比较,差异无统计学意义(χ2分别=0.98、0.42,P均>0.05);除7d手术组血清AST和LDH低于非手术组,差异有统计学意义(t分别=2.59、3.05,P均<0.05),其余时间点血清心肌酶比较差异均无统计学意义(t分别=1.43、1.95、1.02、1.85;1.40、0.73、1.12、1.42;1.78、1.91;1.03、1.15、1.67、1.30,P均>0.05)。结论高血压脑出血患者存在较为普遍的心肌损伤,主要表现为血清心肌酶的升高和不同类型的心电图异常;手术治疗原发性颅内血肿并不能改善其所并发的心肌损伤。Objective To investigate the effects of operation intervention on myocardial damage in patients with hypertensive cerebral hemorrhage. Methods Forty four patients with hypertensive cerebral hemorrhage were divided into operation group and no operation group according to GCS score,blood volume and the clinical and CT manifestations. Myocardial enzymogram and electrocardiogram were observed after 24 hours,3 days,7 days and 15 days. Healthy people were selected as control subjects. Results After 24 hours myocardial enzymogram began to rise, after 3 days it achieved peak, afterward it gradually degraded. The rates of electrocardiographic abnormality after 24 hrs,3 days,7 days and 15 days were 65.91%, 88.64%, 50.55% and 34.09% respectively. The incidence of electrocardiographic abnormality was lower 7 days and 15 days post operation in operation group than that of no operation group, but there was no significant difference （X^2=0.98,0.42, P〉0.05）; there were no significant differences in myocardial enzymogram between the two groups at every point except AST and LDH at the 7 days （t = 1.43,1.95,1.02,1.85;1.40,0.73,1.12,1.42;1.78,1.91;1.03,1.15,1.67,1.30,P〉0.05） Conclusions Myocardial damage is universal in patients with hypertensive cerebral hemorrhage. It displays the rise of myocardial enzymogram and electrocardiographic abnormality. Operation cannot cure its myocardial damage.

关 键 词：手术干预 高血压脑出血 心肌损伤 

分 类 号：R651.12[医药卫生—外科学]