心肌酶谱在急性一氧化碳中毒心肌损伤中的临床价值

杨静杰 李君 孙宝泉

[摘要] 目的 通过观察急性一氧化碳中毒（ acute carbon monoxide poisoning，ACOP） 心肌酶谱的变化，结合心电图情况分析中毒后心肌损伤程度的相关性及其对预后的相应影响。方法 整群选取2009年1月—2013年12月该院收治的90例急性一氧化碳中毒患者分为轻、中、重3组，根据并选取健康患者30例为对照组。患者入院后6 h，入院后72 h及入院后7 d后分别测定心肌酶谱及心电图检查。结果 各中毒组与对照组比较，重度组、轻度组与中度组比较，差异有统计学意义（P<0.01）。中毒组90例中有25例心电图正常，占27.8%；65例心电图异常，占72.2%。在心电图改变中，以ST-T 改变最多见，其次为窦性心动过速。各组之间差异有统计学意义（P < 0.01）。 结论 中毒程度越重，心肌酶谱中各种酶值升高幅度越大，心肌损害越重。心肌酶谱是判断心肌损害程度的主要依据之一，尤其是有两个以上的指标异常时，意义更大。

[Abstract] Objective To analyze the correlation of myocardial damage degree after poisoning and the effect of it on the prognosis combined with electrocardiogram by observing the changes of myocardial enzymogram in the acute carbon monoxide poisoning. Methods 90 cases of patients with acute carbon monoxide poisoning treated from January 2009 to December 2013 were selected and divided into the mild group， the moderate group and the severe group， and 30 cases of healthy patients were selected as the control group， the myocardial enzymogram and electrocardiogram examination were respectively measured at 6 h， 72 h and 7 d after admission. Results There were obvious differences between the moderate group and the control group and between the severe group， the mild group and the moderate group，（P<0.01），of 90 cases in the moderate group， the electrocardiogram was normal in 25 cases， accounting for 27.8%， and abnormal in 65 cases， accounting for 72.2%， in the electrocardiogram change， the ST-T change was the most common and the nodal tachycardia was the second， there were obvious differences between each group， （P<0.01）. Conclusion The more severe the poisoning degree， the bigger the ascending range of each enzyme value in the myocardial enzymogram， the more severe the ？myocardial damage， myocardial enzymogram is one of the main basis for judging the degree of myocardial damage， and the significance is greater especially with more than two abnormal indicators.

[Key words] Acute carbon monoxide poisoning； Myocardial damage； Myocardial enzyme

[基金项目] 聊城市科研局科研项目（编号：201306350349）。