林青 李彤 张胜彦 许媛

[摘要] 目的：探讨创伤性脑损伤患者发生早期心肌酶谱改变与病情严重程度的关系。方法：采用回顾性分析，观察组患者65例，根据入院时GCS评分分为两个亚组：重型（含特重型）脑外伤组（GCS≤8分）15例，轻中型脑外伤组（GCS 9~15分）50例；健康对照组32例，为同期住院耳鼻喉科患者。入院24 h内测定血清心肌酶（ME）[谷草转氨酶（AST）、肌酸肌酶（CK）、肌酸肌酶同工酶（CKMB）、乳酸脱氢酶（LDH）、α-羟丁酸脱氢酶（HBDH）]。结果：脑外伤患者心肌酶升高发生率为75.4%，对照组心肌酶基本正常，两组AST[（35.98±27.70）U/L vs（18.19±3.90）U/L]；CK[（531.28±602.20）U/L vs（89.13±41.80）U/L]、CKMB[（24.05±18.00）U/L vs（12.97±4.20）U/L]、LDH[（227.46±88.90）U/L vs（154.75±26.70）U/L]、HBDH[（175.26±60.20）U/L vs（118.63±18.60）U/L]比较，差异有统计学意义（P<0.05）。病情越重（GCS评分低，死亡风险高），ME值含量越高。死亡患者ME值含量明显高于存活者。结论：急性创伤性脑损伤患者ME值含量升高，早期检查心肌酶可作为伤情判断的指标之一，有利于对患者病情的全面评价。

[关键词] 创伤性脑损伤；心肌酶谱；病情严重程度

[中图分类号] R651.1+5[文献标识码]Ａ [文章编号]1673-7210（2011）11（c）-177-03

Clinical study of early myocardial zymogram changes in patients with traumatic brain injury

LIN Qing1, LI Tong2, ZHANG Shengyan2, XU Yuan2

1. Department of SICU, Beijing Tongren Hospital, Beijing 100730, China; 2. Department of ICU, Beijing Tongren Hospital, Beijing 100730, China

[Abstract] Objective: To investigate the relationship between early myocardial enzymogram changes and severity of illness in patients with traumatic brain injury. Methods: Retrospective analysis was used. 65 patients of the observation group were divided into two groups according to the admission GCS scores: Severe (including particularly severe) traumatic brain injury group (GCS≤8 scores) with 15 patients; Mild and moderate traumatic brain injury group (GCS 9-15 scores) with 50 patients. The healthy control group consisted of 32 patients in the otolaryngological department in the corresponding period. The serum myocardial enzyme (ME) within 24 hours of admission was measured. Results: The incidence rate of ME increase in patients with traumatic brain injury was 75.4% while ME of the control group basically stayed normal, AST[(35.98±27.70) U/L vs (18.19±3.90) U/L], CK [(531.28±602.20) U/L vs (89.13±41.80) U/L], CKMB [(24.05±18.00) U/L vs (12.97±4.20) U/L], LDH[(227.46±88.90)U/L vs (154.75±26.70) U/L], HBDH [(175.26±60.20) U/L vs (118.63±18.60) U/L] with significant differences between the two groups (P<0.05). The severer the disease was (with low GCS scores and high risk of death), the higher the ME value was. ME values of dead patients were significantly higher than those of survivors. Conclusion: Patients with traumatic brain injury have increased ME values, which are in positive correlation with the severity of illness. Early detection of ME can be used as an indicator of the severity of illness and is beneficial to the overall evaluation of the patient's condition.

[Key words] Traumatic brain injury; Myocardial zymogram; Severity

近年来，随着工农业生产的发展脑外伤发病率增高。由于颅脑损伤的致残率和致死率均较高，因而对其伤情判断及预后的临床研究越来越受到关注。研究表明，严重脑外伤可致心电图、血清心肌酶谱发生改变，引起不同程度的心肌损害，在入院24 h内表现显著[1]，是创伤性脑损伤患者继发性死亡的原因之一。但是这些研究对心肌酶谱的改变报道较少，而且心电图的改变多种多样，有的需要参照伤前心电图，故此，笔者认为与心电图相比入院24 h内的心肌酶的升高对伤情的判断更具有意义，为探讨脑外伤患者血清心肌酶的变化及其与疾病严重程度的关系，笔者对同仁医院2008~2009年住院的65例脑外伤急性期成人患者进行心肌酶谱监测，现报道如下：

1 资料与方法

1.1 一般资料

入选标准：2008年8月~2009年8月期间在同仁医院住院的成人患者（年龄>18岁），有急性脑外伤史，发病24 h内入院行化验检查，经头颅CT确诊存在颅脑损伤；……