风湿性心脏病患者围术期心肌酶的动态变化

Perioperative Changes of Myocardial Enzymes Among Rheumatic Heart Diseases

目的 :连续动态观察 40例择期手术的风湿性心脏病患者围术期心肌酶的变化 ,旨在更全面了解心肌受缺血影响的程度和恢复的情况 ,进一步揭示心肌酶围术期变化的规律 ,为临床治疗提供依据。方法 :40例风湿性心脏病患者术前 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 :择期手术的风湿性心脏病患者术前 5种心肌酶均在正常范围 ,术后 1d分别升高到术前的 3～ 12倍 (P <0 .0 5 ) ;术后 3d均有不同程度的恢复 ,CK -MB虽已恢复到正常范围 ,但五种心肌酶仍分别是术前的 2～ 10倍 (P <0 .0 5 ) ;术后 5d继续恢复 ,AST ,LDH和LDH - 1仍高于术前水平 (P <0 .0 5 ) ,CK与CK -MB已恢复到术前水平 (P >0 .0 5 ) ;术后 8dAST也恢复到术前水平 (P >0 .0 5 ) ,但LDH与LDH - 1仍未恢复正常 (P <0 .0 5 )。结论 :择期手术的风湿性心脏病患者术前 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 extent of myocardial injury during operation and the recovery postoperatively and to disclose the pattern of cardiac enzyme changes of rheumatic heart diseases perioperatively. Methods: The venous blood samples from 40 patients of rheumatic heart diseases were taken on the day before operation, and 1, 3, 5, and 8 days ofter operation to measure the serum 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. On the 1st postoperative day, they peaked to three to twelve times of those values preoperatively ( P <0.05). All the 5 cardiac enzymes were still significantly higher than those preoperative values ( P <0.05) although CK-MB had recovered to the normal range on the 3rd postoperative day. CK recovered to the normal range on the 5th day postoperatively. On the 8th postoperative day, LDH and LDH-1 were still significantly higher than their corresponding values measured before operation. We also found that the release of AST, LDH and LDH-1 was positively correlated with the aortic cross-clamping time (CCT). The release was more in those patients whose CCT was longer than 60 minutes compared with those patients who had a CCT shorter than 60 minutes. Conclusion: The 5 cardiac enzymes measured before operation are all within the normal range. CK-MB recovere first; followed by CK and AST; LDH and LDH-1 have not recovered on the 8th postoperative day. The shorter the aortic cross-clamping time is, the less the release of cardiac enzymes. LDH and LDH-1 should be used to evaluate the recovery of myocardium after ischemic and reperfusion injury.