心脏直视手术围手术期CK及CK-MB的动态变化  

The Changes of Perioperative Myocardial Enzymes Undergoing Open Heart Surgery During Coronary Pulmonary Bypass

作　　者：邹恭道[1] 田兴德[1] 齐同谦[1] 王茁[1] 李鸣[1] 田长康[1] 

机构地区：[1]长江大学附属第一医院,湖北荆州434000

出　　处：《长江大学学报（自科版）（下旬）》2006年第3期217-219,共3页Journal of Yangtze University

摘　　要：目的：观察血清肌酸磷酸激酶（CK）及其同工酶（MB）在CPB心脏直视手术围手术期的动态变化，以了解其在围术期的变化规律．为临床诊断治疗提供依据。方法：20例患者分别在术前1d．术后1h、1d（约15～18h）、2、3、4、5、6d晨分别取静脉血，留肝素化血浆测心肌酶，并同时怍标准12导联EKG，20例患者分为冠状动脉搭桥术和先天型心脏病修复术2组。结果；2组患者术前心肌酶均在正常范围，术后lh同时升高到术前的2～43倍，与术前相比有显著性差异（P〈0．05）．2组间心肌酶的释放量没有显著性差异（P〉0．05）．术后CHD组的5种心肌酶较CABG组的要稍微高一些，而CHD组较CABG组恢复的快一些。结论：2组术前心肌酶均在正常范围，CK—MB释放术后1h达高峰，恢复最快．CK次之，术后心肌酶释放的高峰时间和恢复次序基本一致．心脏术后心肌酶升高的倍数如大干5倍尚不能诊断PMI，CK及CK—MB对CPB心脏直视手术后围术期心肌损伤的程度有较高的特异性和敏感度。Objective: To investigate the perioperative changes of serum creatine kinase(CK),creatine kinase isoenzyme(CK-MB) and their effiacacy in diagnosoing myocardial injury after open heart surgery.Methods:On the preoperative day and the 1 hour,1 day,2,3,4,5 and the 6 th day after the heparin-serum was taken to measure the release of myocardial enzymes in 20 patients.In all patients, twelve-lead electrocardiograms recordings were obtained preoperatively and on the 1hour,1,2,3,4,5,6th postoperative day.10 patiens were cornary artery bypass grafting(CABG)and the other were cogenital heart disease(CHD).Result:All the myocardial enzymes measured before the operation were in the normal range.Their release increased abruptly on the 1 hour postoperatively to 2～43 times of before operation(P<0.05). The release of postoperative myocardial enzymes in two group is unevident diversity(P>0.05).But the myocardial enzymes of CHD group were little than that of CABG group, they recovered more rapidly.Conclusion:All he myocardial enzymes measured before the operation were in the normal range.CK-MB increased peak the first hour postoperatively.it recovered on the 6thpostoperative myocardial enzymes in two groups is the same.The postoperative myocardial enzymes which go up more than 5 times can not still diagnosis perioperative myocardial infarction(PMI).The change of serum CK-MB and CK’s activity in patients with open heart surgery undergoing coronary pulmonary bypass(CPB) may be more sensitive and specific to the forepart diagnosis of perioperative myocardial injury.

关 键 词：体外循环 心脏直视手术 心肌酶 

分 类 号：R654.21[医药卫生—外科学]