浅低温阻断与不阻断主动脉心内直视手术血清心肌酶学变化比较  

Comparison of Serum Myocardial Enzymes in Mild Hypothermia Open Heart Surgery Patients with or without Aorta Crossclamping

作　　者：谢才姣[1] 刘流[1] 陈启智[1] 

机构地区：[1]中南大学湘雅二医院麻醉科主治医生

出　　处：《中国现代手术学杂志》2005年第1期73-75,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的　观察浅低温阻断与不阻断主动脉心内直视手术体外循环对心肌损伤的影响。　方法　24例先天性室间隔缺损手术病人随机分为两组:阻断组与未阻断组各 12例。于肝素化时、开放主动脉后 30min(未阻断者于复跳后 30min)、术后 4h、8h、24h抽取血标本, 测定以下五种心肌酶的浓度:天冬氨酸转氨酶 (aspartateaminotransferase, AST)、乳酸脱氢酶 (lactatedehydrogenase, LDH)、α 羟基丁酸脱氢酶 (α hydroxybutyricdehydrogenase, α HBD)、肌酸磷酸激酶 (creatinekinase, CK)及肌酸磷酸激酶同工酶(MBisoenzymeofcreatinekinase, CK MB)。　结果　两组病人术后心肌酶学均有不同程度的升高,但在术后 4h、8h未阻断组AST、LDH、CK明显低于阻断组(P<0. 05), CK MB(术后 4h、8h)、α HBD(4h)非常显著低于阻断组(P<0. 01)。　结论　浅低温不阻断主动脉行心内直视手术可以减少心肌的再灌注损伤。Objective To investigate the myocardial inju ry of mild hypothermia open heart surgery with or without aorta crossclamping. Methods Twenty-four ventricular septal defects (VSD) pat ients were randomly divided into two groups: crossclamping aorta(group Z) and ar ota uncrossclamped (group N). The arterial blood samples were taken at the timep oint of heparinization, and 30 min (blood samples in group N was taken at 30min after rebeating), 4 h, 8h, 24 h after aorta opening to assay the concerntration of serum enzymes. Results Blood myocardial enzymes eleva ted in both groups, but AST, LDH, CK-MB, CK, α-HBD were significantly lower at 4h, 8h postoperatively in group N comparing with group Z. Conclut ion Mild hypothermia open heart surgery with aorta crossclamping can protect myocardium against reperfusion injury.

关 键 词：心内直视手术 不阻断主动脉 低温阻断 心肌酶学变化 肌酸磷酸激酶同工酶 先天性室间隔缺损 天冬氨酸转氨酶 血清 乳酸脱氢酶 再灌注损伤 心肌损伤 体外循环 手术病人 取血标本 羟基丁酸 不同程度 术后 肝素化 24h CK AST 

分 类 号：R726.5[医药卫生—儿科]