常温不停跳心内直视手术冠脉血心肌酶活性变化

Myocardial Enzymatic Changes During Open Heart Surgery on Warm Beating Heart

目的：观察常温心脏不停跳心内直视手术与冷停跳手术冠脉血心肌酶学的变化，明确不停跳手术对心肌损伤的保护作用。方法：２８ 例心内直视手术病人随机分成不停跳与冷停跳组，每组１４ 例。不停跳组分别于体外循环前、体外循环１５ ｍ ｉｎ、体外循环停止时及停后３０ ｍ ｉｎ、６０ ｍ ｉｎ 采血。冷停跳组分别于体外循环前、主动脉阻断时、主动脉开放时、开放后３０ ｍ ｉｎ、６０ ｍ ｉｎ 采冠脉血测心肌酶。结果：不停跳组体外循环开始后各时点血清ＣＫ、ＣＫ－ＭＢ、ＡＳＴ与体外循环前比较明显增高且差异显著，ＬＤＨ值停机前在正常范围，停机３０ ｍ ｉｎ 明显增高，停机６０ ｍ ｉｎＬＤＨ、ＣＫ－ＭＢ及ＡＳＴ降至正常值范围。结论：常温不停跳手术较冷停跳手术能降低心内直视手术患者冠脉血ＬＤＨ、ＣＫ、ＣＫ－ＭＢ及ＡＳＴ活性。

Objective:In this study, myocardial enzymatic changes between warm open heart surgery and cold cardioplegic open heart surgery were observed to evaluate the protective effects on myocardium of warm beating open heart surgery group and cold cardioplegic arrest heart surgery group, with 14 parients in each group. Methods:In the former group, blood was sampled before cardiopulmonary bypass (CPB), 15 min after CPB, end of CPB, 30 min and 60 min after weaning of CPB. While in the other group, blood was sampled before CPB, right after aortic clamp release, end of CPB, 30 min and 60 min after weaning of CPB. Serum myocardial enzymes. Results:In warm beating heart surgery group, serum creatine kinase (CK), creatine kinase isoenzyme (CK MB) and aspartate transferase (AST) values after CPB were significantly higher than the pre CPB value, while lactic acid dehydrogenase (LDH) was in normal range during CPB and significantly increased by 30 min after CPB and 60 min after CPB, LDH, CK-MB and AST were recovered to normal range. ConclusionConclusion: The open heart surgery on warm beating heart does not increase patients serum LDH, CK, CK-MB and AST activities, implying better myocardial protection.