血液停跳液对冠状动脉旁路移植术患者围术期心肌酶的影响

Effect of blood cardioplegia on myocardiac enzymes in coronary artery bypass grafting patients during the perioperative period

目的:了解血液停跳液对心肌在术中缺血再灌注损伤影响的程度和手术后恢复的情况,为临床治疗提供依据。方法:39例冠状动脉旁路移植术(CABG)患者术前1d,术后1、3、5、8d晨分别取静脉血,测定血清谷草转氨酶(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CABG患者术前5种心肌酶均在正常范围,术后1d分别升高到术前的3～15倍(P<0.01);术后3d均有不同程度的恢复,CK-MB已恢复到正常范围,其他4种酶仍显著高于术前水平(P<0.05或P<0.01);术后5d继续恢复,LDH和LDH-1仍高于术前水平(P<0.01),CK也恢复到正常水平,AST虽仍略高于正常水平,但是其与术前测定值相比差异无显著性(P>0.05或P<0.01);术后8dLDH与LDH-1仍未恢复正常(P<0.05)。结论:血液停跳液对CABG患者可以提供满意的心肌保护。择期手术的CABG患者术前5种心肌酶均在正常范围;这些心肌酶的释放术后1d达最高峰,CK-MB恢复最快,CK与AST次之,LDH和LDH-1最慢,术后8d仍明显高于术前水平;要判断心肌损伤的恢复应以LDH和LDH-1的恢复为标准。

Objective To evaluate the effect of blood cardioplegia on the extent of myocardial injury during cardiac surgery and postoperative recovery in coronary artery bypass grafting （CABG） patients by continually detecting the changes of myocardiac enzymes. Methods The venous blood samples of 39 patients undergoing CABG were taken on the day before surgery and days 1, 3, 5, and 8 after surgery to measure the serum levels of AST, CK, CK-MB, LDH and LDH-1. Results The levels of AST, CK, CK-MB, LDH and LDH-1 before surgery were all within the normal range but they peaked up to be three to fifteen times on day 1 after surgery （ P 〈 0. 01 ）. CK, LDH, LDH-1 and AST were still significantly higher on day 3 （P 〈 0.05 or P 〈 0,01） whereas CK-MB became normal. CK and AST recovered to the normal level on day 5, but both LDH and LDH-1 remained higher on day 8 （P 〈 0.05 or P 〈 0, 01）. Conclusion The levels of 5 cardiac enzymes measured before surgery were all within the normal range. They elevated to the peak on day 1 after surgery. CK-MB was the first to become normal, followed by CK and AST. LDH and LDH-1 were the last. Both LDH and LDH-1 should be used as an index to evaluate repair of myocardium after ischemic and reperfusion injury. Blood cardioplegia can offer satisfactory myocardial protection for CAGB patients.