冠状动脉搭桥(CABG)围术期常规心肌酶学变化的分析  

Changes of myocardial enzymes among coronary artery bypass grafting patients during perioperation

作　　者：王维新[1] 张红超[1] 于鲁峰[1] 仲京[1] 万士杰[1] 

机构地区：[1]空军总医院心血管外科,北京100036

出　　处：《空军总医院学报》2005年第1期24-27,共4页Journal of General Hospital of Air Force,PLA

摘　　要：目的研究冠状动脉搭桥(CABG)术后心肌酶学变化的特殊规律为临床治疗提供依据。方法40例CABG患者术前,术后0、4、16、28、40h,术后第3、4、5、7天晨静脉抽血,检测磷酸肌酸激酶(CK)、磷酸肌酸激酶同功酶(CK-MB)、乳酸脱氢酶(LDH)、谷草转氨酶(AST)、谷丙转氨酶(ALT),并按体外循环(ECC)与非体外循环(OPCAB)搭桥及CK-MB正常与否分组分析,引用CK/AST对比分析。结果除了ALT外所有指标都有明显变化,这些心肌酶在术后16～40h基本都升到高峰,LDH变化最早,CK与AST次之;CK与AST恢复较快,体外循环下CABG与OPCAB造成的主要差别表现在术后16h到术后第2天,若按CK/AST分析则主要在16～28h;LDH最慢,尤其表现在体外循环组几乎整个住院观察期都处于升高水平,术后CK-MB升高组的CK值在术后16h到第2天可以高出CK-MB正常组2.5～3.0倍,同时CK/AST在此期间在两组中无明显差异.而在第3天开始出现CK-MB升高组显著升高。结论CK-MB在评价冠脉搭桥术后心肌损伤中的作用应该高度重视;CK、AST、LDH的升高一定根据其升高的幅度、临床表现、必要参考CK-MB来分析,CK、AST的同步大幅度升高要警惕;ECC下搭桥术酶学变化要注意排除心脏外因素,尤其是LDH。Objective To analyse and the pattern of perioperative cardiac enzyme changes after coronary artery bypass grafting. Methods The venous blood samples from 40 patients of coronary artery bypass grafting were taken on the day before operation,postoperative 0,4,16,28,40 h and 3,4,5 and 7 day to measure the serum leveles of AST, CK, CK-MB, LDH and ALT. To analyse cardiac enzyme according to CABG with or without ECC,and according to CK-MB. CK/AST is referenced as a parameter. Results The values of AST,CK,CK-MB,LDH and AST before operation were within the normal range. The 16-40 postoperative hours were their peak (P<0. 05) ,LDH was the first, AST and CK next. During their recovery, AST and CK were fast,LDH lastly. The different between the groups with or without ECC presented at 16 hour to 2 day,and their CK/AST at 16-28 h. CK in the group with high CK-MB peaked to 2. 5 to 3 times of those normal group at 16 hour to 2 day. However, CK/AST had no significantly difference at that time and had significantly difference from 3 day. Conclusion To evaluate the myocardium injury of CABG, the value of CK-MB is first. The value of CK,AST, LDH should be refer to their entents, clinic, CK-MB. The effect outside heart to the enzyme in CABG with ECC shoud be excluded, especially to LDH.

关 键 词：冠状动脉分流术 手术期间 手术后期间 肌酸激酶/分析 L一乳酸脱氢酶/分析 天冬氨酸氨基转移酶类/分析 

分 类 号：R322.11[医药卫生—人体解剖和组织胚胎学]