Grubb N R, Cuthbert D, Cawood P, Flapan A D, Fox K A
Cardiovascular Research Unit, University of Edinburgh, Lauriston Place, UK.
Resuscitation. 1998 Mar;36(3):193-9. doi: 10.1016/s0300-9572(98)00021-5.
After successful resuscitation from cardiac arrest, it is important to identify whether the event has been triggered by a myocardial infarction, since this determines subsequent investigations and management. Previous studies have shown that biochemical indices of infarction become elevated after resuscitation in patients without myocardial infarction. This can lead to overdiagnosis of myocardial infarction in the post-arrest setting. The cause of the elevated enzyme levels is not known, but may involve electrical or mechanical injury to the heart during resuscitation. In this study we aimed to identify the effects of isolated direct current shock on serum levels of creatine kinase (CK), MB creatine kinase mass (MB-CK), and troponin T, and examined the relationships between enzyme levels and the dose of electrical energy used. Thirteen patients were studied who underwent DC cardioversion for atrial fibrillation. Serum was obtained for CK, MB-CK and troponin T estimation before and 10 min after cardioversion, at hourly intervals for 8 h, and 18 h after cardioversion. Total serum CK became significantly elevated after only 3 h and rose to a peak of 1294.4 IU l(-1) (P < 0.02) at 18 h. Post-shock CK levels were strongly correlated with total shock energy (r = 0.8, P < 0.01). Serum MB-CK was significantly elevated at 18 h among patients receiving total shock energies greater than 1000 J than in those receiving lower doses, reflecting a positive correlation (r = 0.64, P < 0.05) between shock energy and peak MB-CK level. Troponin T levels were not significantly elevated after cardioversion. In conclusion, total serum CK levels become significantly elevated early after cardioversion, suggesting rapid wash-out from injured skeletal muscle. MB-CK levels become significantly elevated in individuals receiving high energy shocks, probably due to release of small quantities of the CK-MB isoform from skeletal muscle. The negligible troponin T levels seen after high energy cardioversion indicate that significant myocardial injury does not occur. Electrical injury is not likely to account for the elevated troponin T levels seen after out-of-hospital resuscitation in patients without myocardial infarction.
心脏骤停成功复苏后，确定该事件是否由心肌梗死引发很重要，因为这决定了后续的检查和治疗。既往研究表明，无心肌梗死患者复苏后梗死的生化指标会升高。这可能导致在心脏骤停后环境中心肌梗死的过度诊断。酶水平升高的原因尚不清楚，但可能与复苏过程中心脏的电或机械损伤有关。在本研究中，我们旨在确定单次直流电电击对血清肌酸激酶（CK）、肌酸激酶同工酶MB质量（MB-CK）和肌钙蛋白T水平的影响，并研究酶水平与所用电能剂量之间的关系。对13例因心房颤动接受直流电复律的患者进行了研究。在复律前、复律后10分钟、每小时一次共8小时以及复律后18小时采集血清，用于测定CK、MB-CK和肌钙蛋白T。仅3小时后总血清CK就显著升高，18小时时升至峰值1294.4 IU l(-1)（P < 0.02）。电击后CK水平与总电击能量密切相关（r = 0.8，P < 0.01）。接受总电击能量大于1000 J的患者18小时时血清MB-CK显著高于接受较低剂量的患者，这反映了电击能量与MB-CK峰值水平之间呈正相关（r = 0.64，P < 0.05）。复律后肌钙蛋白T水平未显著升高。总之，复律后早期总血清CK水平显著升高，提示从受损骨骼肌快速清除。接受高能量电击的个体MB-CK水平显著升高，可能是由于骨骼肌释放少量CK-MB同工酶。高能量复律后肌钙蛋白T水平可忽略不计，表明未发生明显心肌损伤。电击损伤不太可能是无心肌梗死患者院外复苏后肌钙蛋白T水平升高的原因。
