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目的探讨足月窒息新生儿出生早期血肌红蛋白(Mb)及血肌酸激酶(CK)浓度变化的临床意义。方法选择2005年3月至2006年5月本院新生儿科出生3 h内入院的足月窒息新生儿,分为轻度窒息组和重度窒息组,测定生后0~3 h Mb和CK水平,同时检测生后0~6 h第一次尿Mb,记录生后24 h内尿量,与无宫内窘迫、窒息及产伤的正常对照组(15例)及脐血对照组(25例)进行比较。结果窒息新生儿(42例)出生早期CK与Mb均高于两个对照组,重度窒息组高于轻度窒息组[Mb:(1071.8±736.1)μg/L比(266.8±189.9)μg/L,CK:(2990.7±625.8)IU/L比(995.7±595.1)IU/L,P均<0.05];CK与Mb浓度呈正相关(重度窒息组r=0.468,轻度窒息组r=0.577,P均<0.05);正常对照组和脐血对照组CK与Mb差异无统计学意义(P>0.05);重度窒息组血、尿Mb与生后1 m in Apgar和第1个24 h尿量均呈负相关(r分别为-0.657和-0.628,P均<0.05)。结论应密切监测窒息新生儿出生后Mb和CK浓度变化,关注新生儿窒息后肌肉损伤的发生及重度窒息儿出生早期尿量变化。
Objective To investigate the clinical significance of early neonatal myoglobin (Mb) and serum creatine kinase (CK) levels in term asphyxia neonatorum. Methods From March 2005 to May 2006, neonates with full-term asphyxia admitted within 3 h after birth in our hospital were divided into mild asphyxia group and severe asphyxia group, and the levels of Mb and CK at 0-3 h after birth were measured. At the same time, the first urine Mb at 0 ~ 6 h after birth was measured. The urine output within 24 h after birth was recorded, and normal control group (15 cases) and umbilical cord blood control group (25 cases) without intrauterine distress, asphyxia and birth trauma, Compare. Results Asphyxial neonates (42 cases) showed higher CK and Mb at birth than those in two control groups, with severe asphyxia group being higher than mild asphyxia group [Mb: (1071.8 ± 736.1) μg / L vs 266.8 ± 189.9 μg / L , CK: (2990.7 ± 625.8) IU / L (995.7 ± 595.1) IU / L, all P <0.05]. There was a positive correlation between CK and Mb concentrations (r = 0.468 in severe asphyxia group and r = 0.577 in mild asphyxia group (P <0.05). There was no significant difference in CK and Mb between normal control group and umbilical cord blood control group (P> 0.05). Serum and urinary Mb in severe asphyxia group were significantly higher than those in 1-month-old Apgar and first 24- (R = -0.657 and -0.628 respectively, all P <0.05). Conclusions The levels of Mb and CK in neonates with asphyxia should be closely monitored. The occurrence of muscle damage after neonatal asphyxia and the changes of urine output in the early stage of neonatal asphyxia should be closely monitored.