心肌酶和心电图在诊治小儿肺炎过程中的变化及其临床意义  

Changes and Clinical Significance of Myocardial Enzyme and Electrocardiography in the Diagnosis and Treatment of Pediatric Pneumonia

作　　者：孙勇[1] 胡伟芳[2] 辛祖超[1] 李文星[3] 杨峥[3] 黄星原[3] 

机构地区：[1]湖北省枝江市人民医院儿科,湖北枝江443200 [2]湖北省枝江市人民医院心内科,湖北枝江443200 [3]武汉大学人民医院儿科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2014年第5期785-790,共6页Medical Journal of Wuhan University

摘　　要：目的:探讨心肌酶和心电图(ECG)在诊治小儿肺炎过程中的变化并分析其临床意义。方法:选自2010年1月-2012年12月在我院治疗的小儿肺炎患者136例,其中,轻症组87例,重症组49例,对照组为体检正常小儿68例。检测小儿肺炎患者治疗前后及正常小儿的肌酸激酶(CK)、同工酶(CK-MB)和心肌肌钙蛋白T(CTnT)的活性,利用非侵入性床边常规ECG记录各组ECG变化特征,并作组间比较分析。结果:与对照组比较,轻症组在治疗前,肺炎患儿血清中除CK水平稍有增加外(P>0.05),CK-MB和CTnT值均显著增高(P均<0.05),有45.98%肺炎患儿出现ECG特征性改变,且以窦性心动过速和心房早搏多见(P<0.01);在重症组,肺炎患儿血清中的CK、CK-MB和CTnT值不仅高于对照组,而且明显高于轻症组(P均<0.01),有79.59%肺炎患儿ECG出现严重异常特征,形式有ST段改变和T波异常,以及P波高尖和束支传导阻滞(和对照组比较,P<0.01,和轻症组比较,P<0.05)。在治疗后,轻症组中小儿肺炎患者CK、CK-MB和CTnT水平回到正常范围(P均>0.05),ECG恢复到窦性心律(和对照组比较,P>0.05);在重症组,只有肺炎患儿的血清中CK水平恢复到正常值水平,CK-MB和CTnT水平还显著高于对照组(P均<0.05),但显著低于治疗前轻症组水平(P<0.01),仍有18.37%肺炎患儿ECG出现异常,难以恢复(与对照组比较,P<0.05),可能与治疗过程中出现死亡病例相关。结论:小儿肺炎患者血清中的CK、CK-MB、CTnT水平随着病情加重均明显增高,ECG发生异常改变,说明小儿感染肺炎后,心肌可能受到影响,且肺炎病程加深,心肌损伤更趋严重。检测小儿肺炎患者血清中的CK-MB和CTnT水平具有非常高的敏感性和特异性,记录ECG具有很好的直观性和实用性,二者在诊断、治疗及预后有关小儿感染肺炎后病情的发生、发展等方面具有非常重要的临床意义。Objective： To discuss the clinical significance of myocardial enzymatic and electrocardiographic（ECG） changes in the diagnosis and treatment of pediatric pneumonia. Methods： A total of 136 pediatric pneumonia cases in our hospital from January 2010 to December 2011 were cho- sen, including 87 mild cases and 49 severe cases. 68 healthy children were chosen as control group. The creatine kinase （CK） and creatine kinase isoenzyme （CK-MB） as well as cardiac troponin T （CTnT） were measured using different biochemical ways, and ECG were recorded in all subects. Results： Compared with control group before treatment, except that CK level was slightly increased （P〉0.05）, CK-MB and CTnT values were significantly increased in mild pediatric pneumonia group （P〈0.05, respectively）. ECG was abnormal in 45.98% cases of mild pediatric pneumonia group （vs control group, P〈0.01）, and most were nodal tachycardia and atrial premature beats. Moreover, CK, CK-MB, and CTnT values in severe group were increased more obviously than those in control group and mild group （all P〈0.01）. ECGs were abnormal in 79.59% cases in severe group, and showed severely alternated ST segment, abnormal T wave and P wave or bundle branch block （vs control group, P〈0.01; and vs mild pediatric pneumonia group, P〈0.05）. On the other hand, compared with that respectively in control group after treatment, CK, CK-MB and CTnT values were significantly decreased, and ECG recovered to normal in mild group. CK level was recovered to normal values, but CK-MB and CTnT values were still in high levels in severe pediatric pneumonia group （all P〈0.01）. ECGs were still ab- normal in 18.37% pediatric pneumonia cases, who were high risk cases. Conclusion： CK, CK- MB and CTnT values were significantly increased, and ECGs were obviously altered according to the disease degrees in pediatric pneumonia cases. The serum indices and ECG changes are useful markers for monitoring the myoeardiac injury in severe pediatri p

关 键 词：小儿肺炎 心肌酶 心电图 心肌损伤 

分 类 号：R725.6[医药卫生—儿科]