体外循环心脏瓣膜置换术患者术后心肌酶谱变化及其与心肌损伤及预后的关系  

Changes of myocardial enzymes and their relationship with myocardial injury and prognosis in patients undergoing extracorporealcirculation heart valve replacement

作　　者：李思晨 叶建明[1] 范庆浩[1] 费苏鹏 郑盛弘 赵涵[1] 张玉梅[1] LI Sichen;YE Jianming;FAN Qinghao;FEI Supeng;ZHENG Shenghong;ZHAO Han;ZHANG Yumei(Cardio-Thoracic Surgery,Jinhua People’s Hospital,Zhejiang,Jinhua 321000,China)

机构地区：[1]浙江省金华市人民医院心胸外科,浙江金华321000

出　　处：《中国现代医生》2022年第30期89-93,共5页China Modern Doctor

摘　　要：目的研究体外循环心脏瓣膜置换术患者术后心肌酶谱变化及其与心肌损伤及预后的关系。方法回顾性选择浙江省金华市人民医院2017年2月至2019年2月住院并接受体外循环心脏瓣膜置换术患者98例,根据瓣膜学术联盟标准临床心肌损伤分为损伤组(n=52)和对照组(n=46)。入组患者均于术前、术后1、7、14d观察谷草转氨酶(aspartate aminotransferase,AST)、乳酸脱氢酶(lactate dehydrogenase,LDH)、肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)、α羟丁酸脱氢酶(α-hydroxybutyrate dehydrogenase,α-HBDH)的变化,对比两组患者术前及术后各时间段心肌酶谱指标变化情况;术后均实施为期2年(截止至2021年2月)随访调查统计死亡情况,分析心肌酶谱指标与预后间的关系。结果入组98例手术患者心肌酶AST、LDH、CK、CK-MB、HBDH分别均于术后1d升高(P<0.05),并于术后7d、14d逐渐下降(P<0.05),而损伤组和对照组变化趋势与此一致,但损伤组术后1d各指标升高情况明显高于对照组(P<0.05)。入组98例手术患者,术后生存率为85.71%,其中损伤组生存率为78.85%,低于对照组生存率93.48%(P<0.05);ROC曲线分析结果显示:术后1 d血清AST的AUC为0.725(95%CI:0.615~0.824)、LDH的AUC为0.685(95%CI:0.567~0.798)、CK的AUC为0.653(95%CI:0.526~0.766)、CK-MB的AUC为0.867(95%CI:0.753~0.934)、HBDH的AUC为0.624(95%CI:0.502~0.745)。结论体外循环心脏瓣膜置换术患者术后心肌酶谱均存在不同程度上升,且心肌受损者上升更明显,且术后1d心肌酶谱上升对其预后存在一定预测价值。Objective To study the changes of myocardial enzymes and their relationship with myocardial injury and prognosis in patients undergoing extracorporeal circulation heart valve replacement.Methods A total of 98 patients undergoing extracorporeal circulation heart valve replacementin the hospital were retrospectively enrolled between February 2017 and February 2019.According to valve academic research consortium(VARC)standards about the clinical myocardial injury,they were divided into injury group(n=52)and control group(n=46).Changes of myocardial enzymes[aspartate aminotransferase(AST),lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),α-hydroxybutyrate dehydrogenase(α-HBDH)]before surgery,at 1 day,7 days and 14 days after surgery were observed.The changes of myocardial enzymes before and after surgery between the two groups were compared.They were follow-up for 2 years(as of February 2021)to statistically analyze death situations.The relationship between myocardial enzymes and prognosis was analyzed.Results The myocardial enzymes(AST,LDH,CK,CK-MB,HBDH)were increased at 1d after surgery(P<0.05),which were gradually decreased at 7 days and 14days after surgery(P<0.05),and the changes trendsbetween injury group and control group were consistent.However,increase of each index at 1 day after surgery in injury group was significantly greater than that in control group(P<0.05).The postoperative survival rate in the 98 patients was 85.71%,the survival rate in injury group was lower than that in control group(78.85%vs 93.48%)(P<0.05).The results ROC of curve analysis showed that the AUC values of serum AST,LDH,CK,CK-MB and HBDH at 1 day after surgery were 0.725(95%CI:0.615-0.824),0.685(95%CI:0.567-0.798),0.653(95%CI:0.526-0.766),0.867(95%CI:0.753-0.934)and 0.624(95%CI:0.502-0.745),respectively.Conclusion The myocardial enzymesincrease in patients after extracorporeal circulation heart valve replacement,whose increase is more significant in patients with myocardial injury.The increased myocar

关 键 词：体外循环心脏瓣膜置换术 心肌酶谱 心肌损伤 预后 

分 类 号：R542.5[医药卫生—心血管疾病]