先天性心脏病、风湿性心脏病及冠状动脉架桥术患者围手术期心肌酶变化的比较

Comparison of perioperative myocardial enzyme changes among congenital,rheumatic and coronary artery diseases

目的 对 10 7例择期手术的先天性心脏病 (CHD组 ,5 3例 )、风湿性心脏病 (RHD组 ,4 0例 )及冠状动脉硬化性心脏病患者 (CAD组 ,14例 )围手术期心肌酶的变化进行动态观察与比较 ,探讨病种是否会影响心肌酶的释放与恢复。 方法 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 (CK ,CK MB)、乳酸脱氢酶及同功酶 1(LDH ,LDH 1)的含量。 结果 3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～ 15倍 (P <0 0 5 ) ;术后 3d均有不同程度的恢复 ,术后 8d时除了RHD及CAD组的LDH和LDH 1仍明显高于术前 ,其他酶的含量均已恢复到正常水平。主动脉阻断时间 (CCT)与心肌酶的释放呈良好的正相关关系。将 3组中CCT大于 6 0min的患者进行比较 ,3组的CCT无差别 (P >0 0 5 ) ;术后 1d时CK MB、CK及AST释放量CHD组较其他两组多 (P <0 0 5 ) ;这 3种酶分别在术后的 3、5、8d 3组同时恢复到了正常水平 ;LDH和LDH 1的释放在术后 1～ 8d均以RHD组较其他两组为高 (P <0 0 5 )。结论 择期手术的CHD、RHD和CAD患者术前心肌酶的释放在正常水平。术后心肌酶释放的高峰时间及心肌酶的恢复次序是一致的。CCT大于 6 0min患者 ,术后 1d时CK MB。

Objective To observe and compare perioperative myocardial enzyme changes in 107 patients with congenital (CHD, n =53), rheumatic (RHD, n =40) and coronary artery (CAD, n =14) diseases, and to find whether different diseases can affect the release and recovery of myocardial enzymes after heart operations. Methods 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: aspartate aminotransferase(AST),creatine kinase (CK), MB isoenzyme of creatine kinase(CK MB), lactate dehydrogenase(LDH) and LDH 1. Results All the enzymes measured before operation in three groups were in the normal range; their release increased abruptly on the 1st day postoperatively to 2-15 times of those before operation; on the 3rd day, they recovered to some degrees, and on the 8th day they recovered to normal in all groups except LDH and LDH 1 in rh and CAD groups. Because the aortic cross clamp time (CCT) had a good positive correlation to the release of myocardial enzymes, those patients whose CCT was over 60 minutes in three groups were compared revealing that the CCT was not different between three groups ( P < 0 05). The release of CK, CK MB and AST was significantly higher in CHD60 group than those in CHD60 and CAD60 groups, they recovered afterwards; while the release of DH and LDH 1 was higher in CAD60 group than those in CAD60 and in CHD60 groups from the 1st day to the 8th day postoperatively. Conclusions The release of all the 5 enzymes measured before operation was in normal range in selected CHD, RHD and CAD patients. The release peak and the recovery order of all enzymes were the same in three groups. The release of CK, CK MB and AST was higher in CHD60 group than those in RHD60 and CAD60 groups on the 1st day. The release of LDH and LDH 1 was higher in RHD60 group than those in CHD60 and CAD60 groups from the 1st day to the 8th day postoperatively. The shorter the CCT is, the less the release of myocardial enzymes. Using the release of LDH and LDH 1 to evaluate the recovery of myocardial injury after open heart operations was recommended.