摘要目的 了解高血压脑出血病人血清心肌酶的动态变化,探讨血清心肌酶水平的改变及其临床意义.方法 选择40例高血压脑出血病人,根据GCS评分及出血量结合临床和CT表现分为有无意识障碍组、不同出血量组、不同出血部位组、血肿是否破入脑室组、手术和非手术治疗组.入院24 h内、3 d、7 d和15 d抽晨血测定心肌酶谱并进行分析,对照组为同期健康体检者.结果 高血压脑出血病人在发病后24 h内血清心肌酶开始升高,3 d达到高峰,以后逐渐下降,15 d接近正常;有意识障碍组血清心肌酶明显高于无意识障碍组,出血量大者血清心肌酶明显高于出血量小者,差异有统计学意义(P<0.05);出血部位不同和血肿是否破入脑室,其血清心肌酶升高比较差异无统计学意义(P＞0.05);手术治疗高血压脑出血在手术后3 d天门冬氨酸氨基转移酶(AST)和7 d AST、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)升高水平明显低于非手术治疗组,差异有统计学意义(P<0 05),但肌酸激酶(CK)升高比较差异无统计学意义(P＞0.05).结论 高血压脑出血病人存在较为普遍的心肌损伤,主要表现为血清心肌酶的升高;血清心肌酶升高与病情严重程度和出血量大小有关,与出血部位和血肿是否破入脑室无关;手术治疗原发性颅内血肿并不能从根本上治疗其所并发的心肌损伤,对脑心综合征的治疗应采取综合措施.

abstractsObjective To investigate the dynamic changes and implication of serum myocardial enzymogram in patients with hypertensivc cerebral hemorrhage. Methods Forty patients of hypertensive cerebral hemorrhage were respectively divided into conscious disturbance group and consciousness group,different hemorrhage volume group,different bleeding parts groups,hematoncus to break into encephalocoele groups,operation treatment group and no operation treatmen group,according to GCS scores, hemorrhage volume and the clinical and CT manifestation. Myocardial enzymogram were observed after 24 hours,3 days,7 days and 15 days,select healthy examination people as normal control subjects. Results 24 hours later myocardial enzymogram begined to rise,after 3 days it achieved peak,afterward it gradually degraded,and it recovered normal 15 days later.Myocardial enzymogram was higher in conscious disturbance group than consciousness group,and it was higher in larger hemorrhage volume group than little hemorrhage volume group,there were significant differences between them(P<0.05). There was no significant difference between different bleeding parts groups, hematoncus to break into encephalocoele groups(P＞0.05). There were significant differences between operation treatment group and no operation treatmen group in AST, CK-MB and LDH after operation treatment 3 days and 7 days (P<0 05),but there was no significant difference between them in CK(P＞0.05). Conclusions Myocardial damage is universal in patients with hypertensivc cerebral hemorrhage,it displays the rise of myocardial enzymogram,the rise of myocardial enzymogram is related with illness severity and hemorrhage volume,but it is not related with bleeding parts and hematoncus to break into encephalocoele,operation treatment cannot cure its myocardial damage fundamentally,the treatment of cerebrocardiac syndrome should be composite.