CAJ | 학술논문

目的研究力竭性运动致心脏损伤的发病情况及临床特点，发现敏感性和特异性较高的检测指标，对其临床分型、诊断标准进行初步探讨。方法对某战区6家总医院及中心部队医院2000年1月至2010年12月因力竭性运动入住心内科的88例作训人员资料进行分析，观察心肌酶、心电图、心脏超声等相关检查指标，记录治疗前后症状、体征及相关检查指标的变化。结果力竭性运动可引起胸闷、心悸、胸痛、头晕、气短、乏力、晕厥等症状，心脏听诊异常；治疗后天冬氨酸转氨酶〔AST（U/L）：20.34±6.33比35.43±25.25〕、α-羟丁酸脱氢酶〔α-HBDH（U/L）：130.47±9.04比168.93±62.69〕、乳酸脱氢酶〔LDH（μmol?s-1?L-1）：2.48±0.62比3.58±1.34〕、肌酸激酶〔CK（U/L）：125.58±67.56比556.42±381.89〕、肌酸激酶同工酶〔CK-MB（U/L）：11.20±4.08比23.09±15.61〕均较治疗前明显降低（P＜0.05或P＜0.01）；5例患者检测了心肌肌钙蛋白T （cTnT），治疗后较治疗前明显降低（μg/L：0.07±0.05比1.26±0.78，P＜0.05）。心电图异常主要表现为窦性心动过缓（16例）、窦性心律不齐（13例）、室性期前收缩（早搏，11例）。心脏超声发现异常者18例，主要表现为瓣膜反流、心功能减低、心脏增大等，其中以瓣膜反流最为常见，均为少量反流。根据临床表现和检查结果，将力竭性心脏损伤初步分为普通型（20例）、心律失常型（56例）、心力衰竭型（2例）、猝死型（10例）。结论力竭性心脏损伤可以表现为不同临床类型，心肌酶、心电图及心脏超声的异常变化是其有力的证据，对其防治应当引起重视。
목적연구력갈성운동치심장손상적발병정황급림상특점，발현민감성화특이성교고적검측지표，대기림상분형、진단표준진행초보탐토。방법대모전구6가총의원급중심부대의원2000년1월지2010년12월인력갈성운동입주심내과적88례작훈인원자료진행분석，관찰심기매、심전도、심장초성등상관검사지표，기록치료전후증상、체정급상관검사지표적변화。결과력갈성운동가인기흉민、심계、흉통、두훈、기단、핍력、훈궐등증상，심장은진이상；치료후천동안산전안매〔AST（U/L）：20.34±6.33비35.43±25.25〕、α-간정산탈경매〔α-HBDH（U/L）：130.47±9.04비168.93±62.69〕、유산탈경매〔LDH（μmol?s-1?L-1）：2.48±0.62비3.58±1.34〕、기산격매〔CK（U/L）：125.58±67.56비556.42±381.89〕、기산격매동공매〔CK-MB（U/L）：11.20±4.08비23.09±15.61〕균교치료전명현강저（P＜0.05혹P＜0.01）；5례환자검측료심기기개단백T （cTnT），치료후교치료전명현강저（μg/L：0.07±0.05비1.26±0.78，P＜0.05）。심전도이상주요표현위두성심동과완（16례）、두성심률불제（13례）、실성기전수축（조박，11례）。심장초성발현이상자18례，주요표현위판막반류、심공능감저、심장증대등，기중이판막반류최위상견，균위소량반류。근거림상표현화검사결과，장력갈성심장손상초보분위보통형（20례）、심률실상형（56례）、심력쇠갈형（2례）、졸사형（10례）。결론력갈성심장손상가이표현위불동림상류형，심기매、심전도급심장초성적이상변화시기유력적증거，대기방치응당인기중시。
Objective To investigate the incidence and clinical characteristics and look for assay or examination indexes or indicators with higher sensitivity and specificity of heart damage induced by exhaustive exercise in order to establish its preliminary clinical classification and diagnostic criteria. Methods In a military region for training staff,the clinical data of 88 soldiers who were admitted to the departments of cardiology in 6 general or central hospitals because of exhaustive exercise from January 2000 to December 2010 were analyzed. The myocardial enzyme, electrocardiogram(ECG),echocardiography and other related examination indexes or indicators were observed,and the changes of symptoms,signs and other relevant assay and examination indexes before and after treatment were recorded. Results Exhaustive exercise could cause the symptoms such as chest tightness,palpitations,chest pain, dizziness,shortness of breath,fatigue,syncope and other symptoms,as well as cardiac auscultation abnormalities. After treatment, aspartate aminotransferase〔AST(U/L):20.34±6.33 vs. 35.43±25.25〕,α-hydroxybutyrate dehydrogenase〔α-HBDH(U/L):130.47±9.04 vs. 168.93±62.69〕,lactate dehydrogenase〔LDH(μmol?s-1?L-1):2.48±0.62 vs. 3.58±1.34〕,creatine kinase〔CK(U/L):125.58±67.56 vs. 556.42±381.89〕,creatine kinase isoenzyme〔CK-MB(U/L):11.20±4.08 vs. 23.09±15.61〕were significantly lower than those before treatment(P<0.05 or P<0.01);cardiac troponin T(cTnT)was detected in 5 patients,its level after treatment was significantly lower than that before treatment(μg/L:0.07±0.05 vs. 1.26±0.78,P<0.05). The ECG abnormalities included primarily sinus bradycardia (16 cases),sinus arrhythmia (13 cases) and premature ventricular contractions (11 cases). Echocardiographic abnormalities appeared in 18 cases,they were chiefly as follows:valvular regurgitation, cardiac dysfunction,cardiac enlargement,etc,among which the most common one was valvular regurgitation(all the refluxes were of small amount). Based on the above clinical manifestations and examination results,the exhaustive cardiac injuries were preliminarily divided into common type(20 cases),arrhythmia type(56 cases),heart failure type(2 cases)and sudden death(10 cases). Conclusions The clinical manifestations of exhaustive heart damage may appear in different types. Abnormal changes of myocardial enzymes,ECG and echocardiography are the strong evidences for the damage. Clinicians should pay attention to its prevention and treatment.