摘要
目的研究不同程度脾脏损伤患者心肌酶谱变化规律及其临床价值.方法根据2014版脾脏损伤治疗方式的专家共识,将脾脏按受损严重程度划分为四级.回顾性分析2018年1月~2022年1月因外伤导致脾脏损伤就诊于六安市人民医院急诊外科行全脾切除术的113例病人临床资料,其中58例Ⅲ、Ⅳ级脾损伤病人作为观察组,55例Ⅰ、Ⅱ级脾损伤病人作为对照组.两组分别在手术前(T0)、手术后第1d(T1)、手术后第3d(T2)、手术后第7d(T3)检测肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)的水平,并分析脾脏损伤严重程度与心肌酶谱之间的关联.结果脾脏损伤的观察组与对照组经过了相应治疗后,全部痊愈出院,在住院及出院后随访三个月内均无心肌梗死等相关疾病的发生;观察组在T0~T3相同时间点肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)均高于对照组,但T3时间点两组CK-MB差异无统计学意义.与同组T0比较,两组T1~T3点CK、CK-MB、LDH均低于T0点,但对照组T1时间点CK-MB与T0比较差异无统计学意义.结论不同程度脾脏损伤患者早期外周血心肌酶谱均升高,且心肌酶谱的升高幅度与脾损伤严重程度呈正相关,提示创伤性脾损伤患者早期可能出现了心肌受损,应尽早检查患者心肌酶谱等生化指标,并予以药物保护心肌等对症治疗.
Objective To study the changes of myocardial enzymes in patients with different degrees of splenic injury and its clinical value.MethodsAccording to the expert consensus on the treatment of spleen injury in the 2014 edition,the spleen was divided into four grades according to the severity of the damage.A retrospective analysis was performed on the clinical data of 113 patients who received total splenectomy in the emergency department of Lu an People's Hospital from January 2018 to January 2022 due to spleen injury caused by trauma.Among them,58 patients with grade Ⅱ and Ⅳ spleen injury were taken as the observation group,and 55 patients with grade Ⅰ and Ⅱ spleen injury were taken as the control group.The levels of creatine kinase(CK),creatine kinase isoenzyme(CK-MB),and lactate dehydrogenase(LDH)were detected before surgery(TO),on the 1st day(T1)after surgery,on the 3rd day(T2)after surgery,and on the 7th day(T3)after surgery in the two groups,respectively,and the correlation between the severity of spleen injury and myocardial enzymes was analyzed.ResultsSpleen injury observation group and control group were all cured and discharged after corresponding treatment,and there was no occurrence of myocardial infarction and other related diseases in the hospitalization and three months'fllow-up after discharge.The levels of CK,CK-MB and LDH in the observation group were higher than those in the control group at the same time points from TO to T3.However,there was no significant difference in CK-MB between the two groups at T3.Compared with TO in the same group,CK,CK-MB and LDH at T1-T3 in the two groups were lower than those at T0,but CK-MB at T1 in the control group was not significantly different from TO.ConclusionThe myocardial zymogram in peripheral blood of patients with different degrees of spleen injury increased in the early stage,and the increasing extent of myocardial zymogram was positively correlated with the severity of spleen injury,suggesting that patients with traumatic spleen injury may have
作者
顾鹏
周正武
韩圣瑾
马建中
GU Peng;ZHOU Zheng-wu;HAN Sheng-jin(Emergency surgery,Graduate school of Bengbu Medical College,Bengbu,Anhui,233004;Emergency Surgery,Lu an Hospital Affiliated to Anhui Medical University,Lu'an 237005,China)
出处
《肝胆外科杂志》
2022年第6期445-448,共4页
Journal of Hepatobiliary Surgery
基金
安徽省医学会2021年急诊临床研究项目(Ky2021002)。
关键词
脾脏损伤
腹部外伤
心肌酶谱
肌酸激酶
肌酸激酶同工酶
乳酸脱氢酶
spleen injury
abdominal trauma
myocardial enzyme spectrum
creatine kinase
creatine kinase isoenzyme
lactate dehydrogenase
