非体外循环冠状动脉旁路移植术围术期心肌酶及心电图改变  

Peri-operative change in ECG and myocardial biomarkers in patients undergoing off-pump coronary artery bypass grafting

作　　者：沈冬焱[1] 何子林 朱朝晖[1] 王学鹏[1] 

机构地区：[1]北京市健宫医院心血管外科,100054

出　　处：《北京医学》2012年第8期749-752,共4页Beijing Medical Journal

摘　　要：目的总结非体外循环冠状动脉旁路移植术后早期心电图及心肌酶学的变化特点,为早期识别围术期心肌梗死(PMI)提供依据。方法连续观察50例非体外循环冠状动脉旁路移植术患者术前和术后第1、2、3、7天心电图及肌钙蛋白I(TNI)、肌红蛋白(MYO)、天冬氨酸氨基转移酶(AST)、肌酸激酶同工酶MB(CK-MB)、乳酸脱氢酶(LDH)及α-羟丁酸脱氢酶(αHBDH)的变化情况。结果本组无确定PMI患者。术后72%的患者心电图出现多种非特异性改变。5个观察时间点中,AST分别为(26.0±20.2)、(32.9±19.7)、(25.1±10.1)、(23.7±13.2)、(26.9+22.3)U/L,TNI分别为(0.216±0.626)、(0.599±1.277)、(0.499±1.086)、(0.308±0.559)、(0.116±0.187)ng/ml,术后各时间点与术前比较,差异无统计学意义(P>0.05);CK-MB[(12.9±7.1),(25.3±20.3),(20.1±7.0),(18.8±10.9),(13.2±5.5)U/L]和MY-O[(51.6±41.5),(276.9±130.1),(195.3±104.7),(121.8±75.9),(63.1±41.6)ng/ml],在术后显著升高并在1周之内恢复。LDH[(205.1±48.9),(326.1±77.5),(295.2±86.5),(265.6±87.3),(245.2±58.0)U/L]和αHBDH[(139.0±40.2),(211.8±56.3),(198.7±58.4),(180.9±69.1),(165.3±39.4)U/L]的变化超过1周。结论单纯依靠心电图的动态演变或心肌酶学的异常变化还不能很好地确定PMI。认识术后常见心电图的异常改变,了解术后心肌酶学的变化规律,结合患者临床循环状况及主观症状的改变综合评估更有助于PMI的正确和及时识别。Objective To recognize early pert-operative myocardial infarction （PMI） in patients undergoing off-pump coronary artery bypass grafting and to explore the characteristics of changes in ECG and myocardial biomarkers. Methods Data of 50 consecutive patients undergoing off-pump coronary artery bypass grafting were collected, and the characteristics changes in ECG, troponin Ⅰ （TNI）, myoglobin （MYO）, aspirate aminotransferase （AST）, ereatine kinase-MB （CK-MB）, lactate dehydrogenase （LDH）, and α-hydroxybutyrate dehydrogenase （αHBDH） were evaluated at the point of pre-operation and 1st, 2nd, 3rd and 7th day after operation. Results No PMI occurred in this study group, 72% patients had non-special ECG changes. On the 5 observed time-points, AST were （26.0±20.2）,（32.9±19.7）,（25.1±10.1）,（23.7±13.2）, （26.9±22.3）U/L, TNI were（0.216±0.626）,（0.599±1.277）,（0.499±1.086）,（ 0.308±0.559）,（0.116±0.187）ng/ml and there were no statistically significant difference between those of the pre-operative and post-operation（P 〉 0.05）. The changes in CK-MB [（12.9 ±7.1）, （25.3±20.3）, （20.1 ±7.0）, （18.8 ±10.9）, （13.2 ±5.5）U/L] and MYO [（51.6 ±41.5）, （276.9 ±130.1）, （195.3 ±104.7）, （121.8±75.9）, （63.1 ±41.6）ng/ml] recovered within one week after operation, while the changes of LDH [（205.1 ±48.9）, （326.1±77.5）,（295.2±86.5）,（265.6±87.3）,（245.2±58.0）U/L] and αHBDH [（139.0±40.2）,（211.8±56.3）,（198.7±58.4）,（180.9±69.1）, （165.3±39.4）U/L] were recovered after one week. Conclusions PMI cannot be identified properly by ECG changes or abnormal myocardial biochemical markers. Combining common abnormal ECG changes and cardiac biomarkers with hemodynamie status as well as symptoms maybe predictive.

关 键 词：冠状动脉旁路移植术 围术期心肌梗死 心肌酶学标记物 心电图 

分 类 号：R654.2[医药卫生—外科学]