论文部分内容阅读
研究重度窒息新生儿横纹肌损伤及溶解发生情况、影响因素及对机体的影响,采用多元逐步回归等方法,以69例足月重度窒息新生儿为研究对象,研究生后0-48h(Ⅰ)、5～7天(Ⅱ)肌酸激酶(CK)的动态变化、影响因素及其对其他生化指标-尿素(UREA)、血钙(Ca)。血磷(P)、血钾(K)和血尿酸(UA)的影响,并对其中10例同期进行血清肌红蛋白检测,分析CK与肌红蛋白间关系。结果显示:①按诊断标准,采用不同正常参考值,重度窒息新生儿横纹肌溶解发生率21.7％～51.7％;②在重度窒息基础上,合并宫内窘迫及经产道出生者CK-I水平较高;③CK-I水平影响Ca-I水平,CK-I越高,Ca-I越低;④重度窒息新生儿肌红蛋白明显高于正常新生儿脐血肌红蛋白(361.8±202.3)ng/ml vs(35.8±11.7)ng/ml,(t=5.263,P<0.001);随着病情的恢复,窒息后CK及肌红蛋白水平均有较显著的下降(P:0.022,P=0.001),生后早期肌红蛋白水平高的病例,其CK恢复较慢(r=0.819,P=0.013)。结论:可以认为重度窒息新生儿中存在横纹肌溶解,其尤易发生于合并宫内窘迫、经产道出生者;横纹肌损伤和溶解影响生化代谢,未发现其有加重窒息后肾脏损伤的作用;随病情恢复,横纹肌损伤及溶解可逐渐恢复。
To study the incidence and influencing factors of striated muscle injury and lysis in neonates with severe asphyxia and the impact on the body by using multiple stepwise regression and other methods to study 69 newborn infants with full-term severe asphyxia at postnatal 0-48h (Ⅰ), 5 ~ 7 days (Ⅱ) creatine kinase (CK) dynamic changes, the influencing factors and its other biochemical indicators - urea (UREA), blood calcium (Ca). (P), serum potassium (K) and serum uric acid (UA) were detected in 10 of them. Serum myoglobin was detected in 10 of them and the relationship between CK and myoglobin was analyzed. The results showed that: ① according to the diagnostic criteria, using different normal reference values, the incidence of rhabdomyolysis in neonates with severe asphyxia was 21.7% ~ 51.7%; ② On the basis of severe asphyxia, CK-I levels in patients with intrauterine distress and birth canal were higher ; ③CK-I levels affect the level of Ca-I, the higher the CK-I, the lower the Ca-I; ④ myoglobin in neonates with severe asphyxia was significantly higher than that of normal neonates (361.8 ± 202.3) ng / ml vs (35.8 ± 11.7) ng / ml, (t = 5.263, P <0.001). CK and myoglobin levels decreased significantly after asphyxia with the recovery of the disease (P = 0.022, P = 0.001) Early cases of high myoglobin levels, the CK recovery was slower (r = 0.819, P = 0.013). Conclusions: Rhabdomyolysis can be considered in neonates with severe asphyxia, especially in those complicated with intrauterine distress and birth canal. Rhabdomyolysis and lysis affect the biochemical metabolism, and it has not been found that renal injury is caused by aggravating asphyxia. Recovery, striated muscle injury and dissolution can be gradually restored.