Lin Chih-Chuan, Chiu Te-Fa, Fang Jia-You, Kuan Jen-Tse, Chen Jih-Chang
Department of Emergency Medicine, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei Shan Hsiang, Tao-Yuan Hsien, Taiwan.
Resuscitation. 2006 Mar;68(3):343-9. doi: 10.1016/j.resuscitation.2005.07.018. Epub 2005 Dec 27.
The serum concentration of cardiac enzymes may be influenced by mechanical and electrical trauma due to cardiopulmonary resuscitation (CPR) attempts. This could complicate the determination of whether an acute myocardial infarction (AMI) had occurred. In this study, only patients without any of the known confounding factors affecting cardiac enzyme release were included, and the specific time course and patterns of serum cardiac enzyme levels after resuscitation were evaluated. The purpose is to help clinicians distinguish between spontaneous myocardial damage and that induced by CPR.
This prospective, observational study was performed in the emergency department on eight patients surviving cardiac arrest. They were selected for not having heart disease, chest trauma or septic shock; and not receiving defibrillation. The median (range) duration of return of spontaneous circulation (ROSC) was 13 min (5-30 min). Cardiac enzyme measurements were taken immediately after ROSC and every 6h thereafter. Although cardiac troponin I (cTnI) level reached as high as 62.6 ng/ml at 24 h in one patient, five of the eight (62.5%) patients had their cTnI level fall below the normal reference range (i.e. 2 ng/ml) by 30 h. The time to maximum and peak concentration of cTnI was 16.50+/-10.99 h and 16.85+/-21.50 ng/ml, respectively. Both MB creatine kinase (CKMB) and total creatine kinase (CK) levels were above their normal reference ranges. In addition, the CKMB/CK ratio exceeded 5% in all patients at any time point during this study.
In this study, the influence of resuscitative procedures - defibrillation excluded - on the release of cardiac enzymes were examined. During 30 h after ROSC cTnI level exhibited a bell-shaped configuration, which is distinct from that after AMI; whereas the enzymatic activities of CKMB and CK, as well as CKMB/CK ratio, were constantly higher than normal. This chronological pattern of cardiac enzyme levels may help physicians differentiate primary cardiac disease from other aetiologies in out-of-hospital cardiac arrests.
心肺复苏（CPR）尝试导致的机械和电击创伤可能会影响心脏酶的血清浓度。这可能会使判断急性心肌梗死（AMI）是否发生变得复杂。在本研究中，仅纳入了没有任何已知影响心脏酶释放的混杂因素的患者，并评估了复苏后血清心脏酶水平的具体时间进程和模式。目的是帮助临床医生区分自发性心肌损伤和心肺复苏诱导的心肌损伤。
这项前瞻性观察性研究在急诊科对8名心脏骤停后存活的患者进行。他们因没有心脏病、胸部创伤或感染性休克；且未接受除颤而被选中。自主循环恢复（ROSC）的中位（范围）持续时间为13分钟（5 - 30分钟）。在ROSC后立即及此后每6小时进行心脏酶测量。尽管一名患者在24小时时心肌肌钙蛋白I（cTnI）水平高达62.6 ng/ml，但8名患者中有5名（62.5%）在30小时时cTnI水平降至正常参考范围（即2 ng/ml）以下。cTnI达到最大浓度和峰值浓度的时间分别为16.50±10.99小时和16.85±21.50 ng/ml。肌酸激酶同工酶（CKMB）和总肌酸激酶（CK）水平均高于其正常参考范围。此外，在本研究期间的任何时间点，所有患者的CKMB/CK比值均超过5%。
在本研究中，研究了排除除颤的复苏程序对心脏酶释放的影响。在ROSC后的30小时内，cTnI水平呈现钟形曲线，这与AMI后的情况不同；而CKMB和CK的酶活性以及CKMB/CK比值持续高于正常。这种心脏酶水平的时间模式可能有助于医生在院外心脏骤停中区分原发性心脏病和其他病因。
