连续测定血清心肌肌钙蛋白Ⅰ和肌酸激酶同工酶在特重度烧伤患者治疗中的临床意义  

Clinical significance of continuous determination of serum cardiac troponin Ⅰ and MB-isoenzyme of creatine kinase in the treatment of patients with extraordinarily severe burns

作　　者：梁丽红[1] 李向云[2] 

机构地区：[1]河北省邢台市人民医院供应室,邢台市054000 [2]河北省邢台市人民医院整形烧伤科,邢台市054000

出　　处：《实用检验医师杂志》2016年第3期168-170,共3页Chinese Journal of Clinical Pathologist

摘　　要：目的观察特重度烧伤患者血清心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）的变化规律，为临床诊断提供依据。方法收集河北省邢台市人民医院2012年1月至2014年6月期间收治的特重度烧伤成年患者20例[总体表面积（TBSA）≥51％，最大烧伤面积为100％，均为Ⅱ°、Ⅲ°烧伤，其中Ⅲ°70％TBSA1例]；检测患者伤后24h内和3、5、7、14、20d的cTnI、CK-MB水平，观察各时间点cTnI、CK—MB和心电图的异常率。结果患者伤后血清cTnI、CK-MB水平均较正常参考值（分别为0～1．7U／L、〈24u，L）明显升高，cTnI伤后24h达高峰（U／L：1．3±1．1），伤后7d恢复正常（U/L：0．8±O．4）；CK-MB于伤后7d达到高峰（U／L：156．1±11．6），达正常参考值的6．5倍，之后逐步恢复正常；各时间点cTnI、CK-MB出现异常值的频率差异均有统计学意义（P均〈0．01）。心电图显示，休克期（伤后24h内）20例（100％）患者心率均〉100次／min，烧伤后24h内T波异常率为5％、ST段异常率为10％。结论特重度烧伤患者伤后血清CK-MB水平明显增高，但对心肌损伤的诊断不具有特异性；血清cTnI是诊断急性心肌损伤的“金标准”。Objective To observe the variation of serum cardiac troponin I （cTnI） and MB-isoenzyme of creatine kinase （CK-MB） in patients with extraordinarily severe burns. Methods Twenty adult patients with extraordinarily severe burns [total body surface area （TBSA）≥ 51%] admitted to Xing tai People＇s Hospital in Hebei Province from January 2012 to June 2014 were enrolled. The maximum burn surface area was 100%, all were Ⅱ° and Ⅲ° burn,Ⅲ° 70% TBSA in 1 case. The levels of cTnI and CK-MB within 24 hours and 3, 7, 14, 20 days after injury were determined, the changes in abnormal rate of cTnI, CK-MB, and electrocardiogram （ECG） were monitored at each time point. Results Serum cTnI and CK-MB after injury showed significant change as compared with normal value （0-1.7 U/L and 〈 24 U/L respectively）, serum cTnI peaked within 24 hours after injury （U/L： 1.3 ± 1.1） and resumed to normal at 7 days after injury （U/L： 0.8±0.4）. CK-MB reached a peak at 7 days after injury （U/L： 156.1 ± 11.6）, which maximum was up to 6.5 times of the normal value, and later reduced to normal gradually. The frequencies of abnormal values of cTnI and CK-MB at different time points were statistically significant （P all 〈 0.01）. It was shown by EEG that heart rate 〉 100 bpm was found in 20 patients （100%） in the shock stage （within 24 hours after injury）, and T-wave abnormalities （5%） and ST-segment abnormalities （10%） were appeared within 24 hours after the burn. Conclusions The serum CK-MB values were increased after injury in patients with extraordinarily severe burns, but the diagnosis of myocardial injury was not specific. Serum cTnI is the ＂gold standard＂ for diagnosis of acute myocardial injury.

关 键 词：烧伤 特重度 肌钙蛋白Ⅰ 肌酸激酶同工酶 

分 类 号：R644[医药卫生—外科学]