风湿性心脏病与成人先心病围手术期心肌酶变化的比较

Comparison of myocardial enzyme changes between rheumatic heart disease and adult congenital heart disease perioperative period

目的通过对风湿性心脏病(RHD组)和成人先天性心脏病(CHD组)患者围术期心肌酶的变化进行动态观察,探讨不同病种的手术对心肌损伤的影响。方法44例成人患者接受心内直视手术,其中RHD组24例患者接受二尖瓣置换术;CHD组20例患者为先天性房间隔缺损或室间隔缺损。手术前1d、术后1d、3d、5d和8d分别取静脉血,测定并比较两组患者血清门冬酸氨基转移酶(AST)、肌酸激酶(CK)及其同工酶MB(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBHD)的变化。结果两组患者术前5种心肌酶均在正常范围,术后1d分别升高到术前的2～11倍(P<0.01),术后3d均有不同程度的恢复,到术后8d,除两组的LDH和HBHD仍高于术前外,其它酶的释放量均已恢复到正常水平。术后心肌酶的释放量RHD组较CHD组为高(P<0.05)。结论择期手术的RHD和CHD患者术前心肌酶的释放量在正常水平。术后两组心肌酶释放的高峰时间及心肌酶的恢复次序是一致的,术后RHD组患者心肌酶的释放量较CHD组患者高。

objective To observe and compare perioperative myocardial enzyme changes among patients with rheumatic heart disease （RHD group） and coronary atherosclerotic heart disease （CHD group）, trying to find out whether different disease can affect the damage of myocardial enzymes after open-heart operations. Methods Open heart operation was taken for 44 patients. 24 patients in RHD group were all got replacement of mitral valve, and the last 20 patients were all undergoing inborn atrial septal defect or interventricular septal defect. On the day before operation and the 1st, 3rd, 5th and the 8th day after operation, the venous blood was taken to measure the release of myocardial enzymes in two groups： aspartate transaminase（AST）, creatine kinase（CK）, creatine kinase MB（CK-MB）, lactate dehydrogenase （LDH）, and α hydroxybutyrate dehydrogenase （HBHD）. Results Two groups of five kinds of myocardial enzymes preoperative patients were in the normal range, their release increased on the first day postoperatively to 2 -11 times of those before operation （P 〈0. 01 ）. On the 8th day, they recovered to normal except that LDH and HBHD in two groups were still higher than those measured before operation（P 〈0.05）, while the release of myocardial enzymes was higher in RHD group than that in CHD group. Conclusion The release of all the 5 enzymes measured before operation was in normal range in RHD patients and CHD patients. The peak of the release and the recovery order of all enzymes were the same in two groups. The peak of the release and the recovery of all enzymes are the same in two groups. The RHD group patients had a higher release of all 5 myocardial enzymes than CHD group patients had after operation.