非体外循环冠脉架桥手术后的心肌酶谱变化  

Change of myocardial zymogram after coronary artery bypass grafting without cardiopulmonary bypass

作　　者：陈敏[1] 巩固[1] 熊利泽[1] 汪晨[1] 邵继风[1] 熊东方[1] 

机构地区：[1]第四军医大学西京医院麻醉科,陕西西安710033

出　　处：《第四军医大学学报》2003年第14期1314-1316,共3页Journal of the Fourth Military Medical University

摘　　要：目的 :通过心肌酶谱的变化 ,评估了解体外循环和非体外循环两种冠脉架桥手术 (CABG)心肌损伤的程度 .方法 :4 8例患者中 2 5例行非体外循环冠脉架桥手术 (offpumpCABG) ,2 3例行体外循环冠脉架桥手术 (CABGwithCPB) .分别于手术开始前和手术开始后 2 ,2 4 ,4 8,72 ,96 ,12 0h抽取静脉血检测谷草转氨酶 (AST) ,乳酸脱氢酶 (LDH) ,磷酸肌酸激酶 (CK) .结果 :术后CPB组的AST的最高值 (2 .5 8μkat·L-1)明显比offpump组高 (1.2 5 μkat·L-1,P =0 .0 0 9) .LDH也有相似的现象 ,CPB组 (9.84 μkat·L-1)明显高于offpump组 (8.82 μkat·L-1,P =0 .0 0 1) .术后CPB组CK的峰值 (2 2 .78μkat·L-1)明显高于offpump组 (14 .2 0 μkat·L-1,P =0 .0 3) .结论 :offpumpCABG比CPBCABG有较轻微的心肌损伤 .AIM: To assess the myocardial damage in coronary artery bypass grafting( CABG) with or without cardiopulmonary bypass (CPB) by detecting the changes of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK). METHODS: Twenty five patients were selected for off pump CABG and twenty three patients were selected for CABG with CPB. CK, AST and LDH were measured before and after operation. RESULTS: The maximum AST was significantly higher ( P = 0.009) in the group operated with CPB (2.58 μkat·L -1 ) than that without it (1.25 μkat·L -1 ) after operation. A similar phenomenon was observed in LDH difference (9.84 μkat·L -1 and 8.82 μkat·L -1 ) with and without CPB, ( P =0.001). The postoperative peak values of creatine kinase (22.78 μkat·L -1 vs 14.20 μkat·L -1 ) was significantly higher ( P = 0.03) with than without CPB. CONCLUSION: Coronary artery bypass grafting without cardiopulmonary bypass causes less myocardial injury than that with CPB.

关 键 词：冠状动脉分流术 非体外循环 心肌/酶学 

分 类 号：R614.2[医药卫生—麻醉学]