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. ......