心肌酶譜在急性一氧化碳中毒心肌損傷中的臨床價值

楊靜杰 李君 孫寶泉

[摘要] 目的 通過觀察急性一氧化碳中毒（ acute carbon monoxide poisoning，ACOP） 心肌酶譜的變化，結合心電圖情況分析中毒后心肌損傷程度的相關性及其對預后的相應影響。方法 整群選取2009年1月—2013年12月該院收治的90例急性一氧化碳中毒患者分為輕、中、重3組，根據并選取健康患者30例為對照組。患者入院后6 h，入院后72 h及入院后7 d后分別測定心肌酶譜及心電圖檢查。結果 各中毒組與對照組比較，重度組、輕度組與中度組比較，差異有統計學意義（P<0.01）。中毒組90例中有25例心電圖正常，占27.8%；65例心電圖異常，占72.2%。在心電圖改變中，以ST-T 改變最多見，其次為竇性心動過速。各組之間差異有統計學意義（P < 0.01）。 結論 中毒程度越重，心肌酶譜中各種酶值升高幅度越大，心肌損害越重。心肌酶譜是判斷心肌損害程度的主要依據之一，尤其是有兩個以上的指標異常時，意義更大。

[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

[基金項目] 聊城市科研局科研項目（編號：201306350349）。