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目的探讨不同窒息程度新生儿治疗前后血清肌钙蛋白-I(cTnI)水平变化及QT离散度的变化及其临床意义。方法收集30例轻度窒息新生儿(轻度窒息组),20例重度窒息新生儿(重度窒息组)出生后24h内及治疗后第7天的cTnI与肌酸磷酸激酶同工酶(CK-MB);同时第1天及第7天对收集病例进行心电图检测计算QT离散度,并与围产期无窒息史的20例新生儿(对照组)进行比较。结果窒息组新生儿生后第1天血清cTnI与CK-MB及QT离散度均较对照组明显升高(P均<0.01),且重度窒息组较轻度窒息组cTnI与CK-MB升高更明显(P均<0.01),表明窒息程度越重血清cTnI与CK-MB升高越明显。治疗7d后窒息新生儿cTnI与CK-MB水平及QT离散度均能下降,与治疗前(第1天)比较差异有统计学意义(P均<0.01)。结论 cTnI与CK-MB均能敏感检出窒息新生儿心肌损伤,且随着病情好转cTnI与CK-MB及QT离散度均有明显下降,但由于CK-MB影响因素较多,且活性持续时间较短,目前多用cTnI作为反映心肌损害指标,其联合QT离散度检测能早期敏感检出窒息后缺氧缺血性心肌损害,有助于疗效判断及病情与预后评估。
Objective To investigate the changes of serum troponin-I (cTnI) levels and QT dispersion in neonates with different degree of asphyxia and their clinical significance. Methods Thirty newborns with mild asphyxia (mild asphyxia group), cTnI and CK-12 were collected after 24 hours of birth in 20 severe asphyxia neonates (severe asphyxia group) and 7 days after treatment. MB). On the first day and the seventh day, the QT dispersion was calculated by electrocardiogram (ECG) in the collected patients and compared with 20 newborns with no asphyxia in the perinatal period (control group). Results Compared with the control group, the levels of cTnI, CK-MB and QT in newborn infants after asphyxia were significantly higher than those in control group (all P <0.01), and cTnI and CK-MB in severe asphyxia group were higher than those in mild asphyxia group (P <0.01), indicating that the more severe asphyxia serum cTnI and CK-MB increased more significantly. After 7 days of treatment, cTnI, CK-MB levels and QT dispersion of neonatal asphyxia decreased, compared with that before treatment (day 1) (all P <0.01). Conclusions Both cTnI and CK-MB are sensitive to detect myocardial damage in asphyxiated neonates, and as the condition is improved, cTnI, CK-MB and QT dispersion are obviously decreased. However, due to the influence of CK-MB, the duration of activity Short, the current use of cTnI as a reflection of myocardial damage indicators, combined with QT dispersion detection early detection of asphyxia hypoxia-ischemic myocardial damage sensitive to help determine the efficacy and prognosis of the disease and assessment.