急性颅脑损伤患者血清淀粉酶、乳酸水平与继发心脏损伤关系的研究(1)
【摘要】 目的：探討急性颅脑损伤患者血清淀粉酶、乳酸水平与继发心脏损伤的关系。方法：将2015年4月-2017年6月本院收治的140例急性颅脑损伤患者根据GCS评分将其分为轻度颅脑损伤组、中度颅脑损伤组、重度颅脑损伤组；根据颅脑损伤部位分六个亚组：硬膜下出血组、硬膜外出血组、脑挫裂伤(弥漫性轴索损伤)组、脑室出血组、脑干损伤组、蛛网膜下腔出血组。分别于入院即刻、24 h、72 h、7 d、10 d完善血清淀粉酶、乳酸、心电图、hs-cTnT、NT-proBNP检查；于第1、3、7、10天完善心脏彩超检查，记录心脏左室射血分数(LVEF)，根据心电图、hs-cTnT、NT-proBNP、LVEF有无异常分为心脏损伤组(观察组)与心脏正常组(对照组)，将心脏损伤组分为心肌损伤、心律失常、心功能不全，进行统计学处理，对各组间进行分析比较。结果：急性颅脑损伤患者继发心脏损伤组的血清淀粉酶、乳酸水平高于心脏正常组，比较差异有统计学意义(P<0.05)。继发心脏损伤组中，心功能不全患者NT-proBNP最高，心肌损伤患者比心律失常患者高，比较差异均有统计学意义(P<0.05)；心功能不全患者LVEF比心肌损伤组、心律失常组低，比较差异均有统计学意义(P<0.05)；心肌损伤患者hs-cTnT最高，心功能不全患者比心律失常患者高，比较差异均有统计学意义(P<0.05)；心律失常患者心电图异常最多，比较差异有统计学意义(P<0.05)，心脏损伤患者与心功能不全患者差别不大，比较差异无统计学意义(P>0.05)。急性颅脑损伤患者病情越重，淀粉酶、乳酸水平越高，比较差异有统计学意义(P<0.05)，其中脑干损伤患者淀粉酶、乳酸水平最高，比较差异有统计学意义(P<0.05)。结论：急性颅脑损伤患者血清淀粉酶、乳酸水平与继发心脏损伤有密切相关性，可作为判断急性颅脑损伤后有无合并继发心脏损伤，以及判断急性颅脑损伤病情严重程度的临床监测指标，为临床上急性颅脑损伤患者早期发现、早期干预心脏继发损伤提供一条新的途径，值得临床推广。
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【关键词】 急性颅脑损伤； 血清淀粉酶； 乳酸； 心脏损伤
Relationship between Serum Amylase，Lactic Acid Levels and Secondary Heart Injury in Patients with Acute Craniocerebral Injury/HU Keliang，WU Yonghao，CHEN Daiyang，et al.//Medical Innovation of China，2018，15(01)：001-005
【Abstract】 Objective：To investigate the relationship between serum amylase，lactic acid levels and secondary heart injury in patients with acute craniocerebral injury.Method：The patients from April 2015 to June 2017 in our hospital 140 cases of acute craniocerebral injury according to GCS score will be divided into mild craniocerebral injury group， moderate craniocerebral injury group， severe craniocerebral injury group.They were divided into six sub groups according to the location of brain injury：subdural hemorrhage group，extradural hemorrhage group，cerebral contusion (diffuse axonal injury)group，intraventricular hemorrhage group，subarachnoid hemorrhage group，brain injury group.They were admitted to hospital immediately，24 h，72 h，7 days，10 days to improve the serum amylase，lactic acid，hs-cTnT，NT-proBNP，ECG examination；improve cardiac ultrasound examination in first，third，seventh and 10 days，recorded in the left ventricular ejection fraction (LVEF)，according to hs-cTnT，NT-proBNP，LVEF，ECG abnormal divided into cardiac injury group (observation group) and normal heart group (control group)；the cardiac injury group were divided into myocardial injury，cardiac arrhythmia， heart failure.Statistical analysis was carried out and the comparison among the groups was made.Result： The levels of serum amylase and lactic acid in patients with secondary heart injury after acute craniocerebral injury were higher than those in the normal heart group， and there was statistical significance(P<0.05).Which group of secondary heart injury，heart failure in patients with the highest NT-proBNP， myocardial injury in patients with arrhythmia than patients，with statistical significance(P<0.05)；heart failure in patients with LVEF injury group，arrhythmia group was lower than the heart，with statistical significance(P<0.05)；hs-cTnT patients with cardiac muscle injury， heart function all patients than in patients with arrhythmia， had statistical significance(P<0.05)；cardiac arrhythmia in patients with abnormal ECG， there was statistical significance(P<0.05)，cardiac injury in patients with heart failure in patients with little difference，no statistical significance(P>0.05).The more severe the patients with acute craniocerebral injury，the higher the amylase and lactic acid levels were， with statistical significance(P<0.05).The levels of amylase and lactic acid in the patients with brain stem injury were the highest， with statistical significance(P<0.05).Conclusion：Acute brain injury is closely related with the level of serum amylase and lactic acid in patients with secondary heart injury，can be used to evaluate the acute craniocerebral injury with and without secondary heart injury，and clinical disease monitoring indicators to assess the severity of acute craniocerebral injury， acute craniocerebral injury patients for clinical early detection， and provides a new way for early damage secondary cardiac intervention is worthy of promotion., 百拇医药(胡克亮 吴咏豪 陈带洋 王蔚浩 邓乐华 梁淑兰)
, http://www.100md.com
【关键词】 急性颅脑损伤； 血清淀粉酶； 乳酸； 心脏损伤
Relationship between Serum Amylase，Lactic Acid Levels and Secondary Heart Injury in Patients with Acute Craniocerebral Injury/HU Keliang，WU Yonghao，CHEN Daiyang，et al.//Medical Innovation of China，2018，15(01)：001-005
【Abstract】 Objective：To investigate the relationship between serum amylase，lactic acid levels and secondary heart injury in patients with acute craniocerebral injury.Method：The patients from April 2015 to June 2017 in our hospital 140 cases of acute craniocerebral injury according to GCS score will be divided into mild craniocerebral injury group， moderate craniocerebral injury group， severe craniocerebral injury group.They were divided into six sub groups according to the location of brain injury：subdural hemorrhage group，extradural hemorrhage group，cerebral contusion (diffuse axonal injury)group，intraventricular hemorrhage group，subarachnoid hemorrhage group，brain injury group.They were admitted to hospital immediately，24 h，72 h，7 days，10 days to improve the serum amylase，lactic acid，hs-cTnT，NT-proBNP，ECG examination；improve cardiac ultrasound examination in first，third，seventh and 10 days，recorded in the left ventricular ejection fraction (LVEF)，according to hs-cTnT，NT-proBNP，LVEF，ECG abnormal divided into cardiac injury group (observation group) and normal heart group (control group)；the cardiac injury group were divided into myocardial injury，cardiac arrhythmia， heart failure.Statistical analysis was carried out and the comparison among the groups was made.Result： The levels of serum amylase and lactic acid in patients with secondary heart injury after acute craniocerebral injury were higher than those in the normal heart group， and there was statistical significance(P<0.05).Which group of secondary heart injury，heart failure in patients with the highest NT-proBNP， myocardial injury in patients with arrhythmia than patients，with statistical significance(P<0.05)；heart failure in patients with LVEF injury group，arrhythmia group was lower than the heart，with statistical significance(P<0.05)；hs-cTnT patients with cardiac muscle injury， heart function all patients than in patients with arrhythmia， had statistical significance(P<0.05)；cardiac arrhythmia in patients with abnormal ECG， there was statistical significance(P<0.05)，cardiac injury in patients with heart failure in patients with little difference，no statistical significance(P>0.05).The more severe the patients with acute craniocerebral injury，the higher the amylase and lactic acid levels were， with statistical significance(P<0.05).The levels of amylase and lactic acid in the patients with brain stem injury were the highest， with statistical significance(P<0.05).Conclusion：Acute brain injury is closely related with the level of serum amylase and lactic acid in patients with secondary heart injury，can be used to evaluate the acute craniocerebral injury with and without secondary heart injury，and clinical disease monitoring indicators to assess the severity of acute craniocerebral injury， acute craniocerebral injury patients for clinical early detection， and provides a new way for early damage secondary cardiac intervention is worthy of promotion., 百拇医药(胡克亮 吴咏豪 陈带洋 王蔚浩 邓乐华 梁淑兰)