非体外循环下冠状动脉架桥术患者围术期心肌酶的动态变化

Perioperative changes of myocardial enzymes among off-pump coronary artery bypass grafting patients

目的了解非体外循环下冠状动脉架桥术(OPCAB)患者围术期心肌酶的动态变化。方法13例OPCAB患者术前1d,术后1、3、5、8d晨分别取静脉血,测定血清天冬氨酸转氨酶(AST)、磷酸肌酸激酶及同功酶MB(CK,CK-MB)、乳酸脱氢酶及同功酶1(LDH,LDH-1)。结果择期手术的OPCAB患者术前5种心肌酶均在正常范围,术后1d达到高峰(P<0.05);术后3dCK-MB恢复到正常范围,其他心肌酶比术前测定值高,但差异无统计学意义(P>0.05);术后5dCK,术后8dLDH、LDH-1恢复到正常水平,AST在手术后的所有测定值与手术前测定值相比差异均无统计学意义(P>0.05)。结论择期OPCAB患者术前5种心肌酶均在正常范围;术后1d达最高峰,CK-MB恢复最快,LDH和LDH-1恢复最慢。OPCAB是一种对心肌损伤很小的手术方法。

Objective To evaluate the pattern of perioperative cardiac enzyme changes among off-pump coronary artery bypass （OPCAB） grafting operation. Methods Venous blood samples from 13 OPCAB patients on the day before operation, postoperative day 1, 3, 5, and 8 were analyzed to test levels of AST, CK, CK-MB, LDH and LDH-1. Results The values of AST, CK, CK-MB, LDH and LDH-1 before operation were within the normal range, which peaked on the 1st postoperative day （P〈0.05）. CK-MB had recovered to the normal range on the 3rd postoperative day and other enzymes measured were higher than their corresponding values measured before operation but the differences were not significant. CK recovered to baseline on the 5th and LDH , LDH-1 on the 8th postoperative day, AST did not increase significantly after operation. Conclusion The 5 cardiac enzymes measured before operation are all within the normal range. CK-MB recovered first; followed by CK; LDH and LDH-1. OPCAB is a quite safe operation for its relatively minor myocardial injury.