创伤后肝功能变化及其临床意义

目的:探讨创伤后早期肝功能损害各指标的变化及其临床意义.方法:分析2006-05/2006-08我院创伤骨科入院患者719例中肝功能损害105例伤后24 h及48 h内肝功能指标血清丙氨酸氨基转移酶(ALT)、天门氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、乳酸脱氢酶(LDH)、总胆红素(TBIL)、结合胆红素(DBIL)、白蛋白(ALB)、凝血酶原时间(PT).结果:创伤后肝损害的发生率为14.6%,肝功能指标ALT,AST, ALP,GGT, LDH,ALB,TBIL和PT异常发生率分别为91.4%,64.8%,42.9%,61.9%,27.6%,20.9%,30.5%,5.7%;创伤后ALT,AST和GGT升高1-3倍者分别为78例(81.3%),49例(72.1%)和42例(64.6%).严重创伤患者出现ALB降低、TBIL升高及PT延长(P＜0.001),创伤后肝功能指标ALT、AST、ALP及GGT48 h与24h相比明显升高(P＜0.01).结论:创伤后早期即可出现肝功能损害,肝功能指标一般呈轻中度升高,当创伤伤情严重及并发症多时,可出现ALB降低、黄疸及PT延长,创伤后黄疸为肝细胞性黄疸,可能与胆汁淤积无关.     

老年科老年急性感染性疾病致肝功能损害临床分析

目的分析老年人急性感染性疾病致肝损的临床特点. 方法 164例合并肝损的急性感染性疾病患者,老年组89例,对照组75例.治疗后第3周末,比较2组病死率、异常肝功能指标及治愈率. 结果①治疗前老年组丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(SB)值高于对照组(P＜0.05或P＜0.01);②老年组病死率高于对照组(P＜0.05);③治疗后第3周末,2组ALT、AST、GGT、ALP、SB值均较治疗前显著降低(P＜0.05或P＜0.01);老年组ALT、AST、GGT、ALP治愈率低于对照组(P＜0.05). 结论老年急性感染性疾病致肝损程度较严重,完全恢复较慢,应加强对原发病的积极治疗及护肝措施.     

浅中低温体外循环不阻断心肌血流心内直视手术的临床对比研究

目的评价浅低温心脏不停跳及中低温不阻断心肌血流室颤性停搏下心内直视手术的临床对比效果。方法将263例患者分为中低温室颤性停搏组(94例)及浅低温心脏不停跳组(169例),常规插管建立体外循环,转机后阻断上、下腔静脉并降温,不阻断升主动脉(如手术位于主动脉根部的成人患者,则阻断升主动脉并经冠状静脉窦持续逆行灌注),不使用心脏停搏液;鼻咽温度分别于浅低温心脏不停跳(32±1)℃、中低温室颤性停搏(26℃～27℃)下行心内直视手术。结果浅低温组手术死亡4例,中低温组死亡3例。两组术中转机时间、术后呼吸机辅助时间、强心药物的使用及心律失常的发生情况等差异无统计学意义。无一例发生空气栓塞。结论浅低温心脏不停跳及中低温室颤性停搏下心内直视手术都具有较好的心肌保护效果,但在中低温下手术更有利于心内的操作,对血液的保护效果更优,可推荐成为一种安全、可行的心肌保护方法。     

84例体外循环心脏直视手术对肝功能的影响

目的:探讨体外循环心脏直视手术对肝功能的影响。方法:84例体外循环心脏直视手术患者于术前,术后第1、2、7天检查肝功能指标。结果:手术后肝功能异常者占28.5％(24/84);手术后谷丙转氨酶、谷草转氨酶水平无显著变化,总胆红素、直接胆红素水平显著升高(P<0.05)。结论:体外循环心内直视手术对肝功能有一定的影响,但不影响患者病情的康复。     

心脏不停跳法对老年二尖瓣置换术患者心肌的保护作用

浅低温体外循环(cardiopulmonary bypass)心脏不停跳心内直视手术是近年来开展的一种新的心肌保护方法.我们通过检测患者围手术期中心静脉血肌钙蛋白(cTnI)及炎性细胞因子的变化,并观察患者术后的临床恢复情况,探讨浅低温体外循环心脏不停跳心内直视手术,对老年人二尖瓣置换术患者的心肌保护效果及可能的机制.     

1780例先天性心脏病心内畸形的外科治疗

目的 :回顾分析 1780例先天性心脏病心内畸形的外科治疗疗效 ,并比较二种心脏停搏液灌注心脏停跳和不停跳心内直视手术的疗效。方法 :1780例患者均在全麻体外循环下进行手术 ,其中采用冷晶体心脏停搏液灌注心脏停跳下手术 (冷晶体组 ) 6 4 3例 ,冷血心脏停搏液灌注心脏停跳下手术(冷血组 ) 2 31例 ,心脏不停跳手术 (不停跳组 ) 90 6例。心脏不停跳心内直视手术仍常规建立体外循环 ,置左心房引流管 ,降温至 (32± 1)℃并维持 ,仅阻断上下腔静脉 ,不阻断主动脉 ,维持灌注压在 6 0mmHg(1mmHg =0 133kPa) ,心脏跳动下进行畸形矫正 ,方法同停跳下手术。结果 :手术早期死亡 73例 (死亡率3 8% ) ,其中冷晶体组手术死亡 4 2例 (死亡率 6 5 % ) ,残余室间隔缺损 6例 (发生率 0 9% ) ;冷血组手术死亡 7例 (死亡率 3 0 % ) ;不停跳组手术死亡 2 4例 (死亡率 2 6 % ) ,其余均痊愈出院 ,随访 6个月～ 10年 ,恢复良好。结论 :先天性心脏病外科治疗有较好疗效 ,心脏不停跳心内直视手术 ,是一种可行而有效的心肌保护方法 ,并可简化操作 ,提高手术成功率。     

慢性铝过负荷对大鼠的肝损伤作用

目的探讨慢性铝过负荷对大鼠肝功能和形态学影响,并初步观察其机制。方法 Wistar大鼠灌胃给予葡萄糖酸铝(Al3+200 mg/kg),1次/d,每周5 d,连续20 w,建立慢性铝过负荷大鼠模型。采用生化方法检测大鼠血浆丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT),以及肝超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量;采用等离子体原子发射光谱分光光度仪检测肝组织Al3+含量;采用HE染色观察大鼠肝组织病理形态变化。结果慢性铝过负荷致大鼠肝组织铝含量明显增高,肝细胞出现明显空泡变性、颗粒变性和点状坏死,血浆ALT和AST浓度有增高的趋势,ALP和GGT水平显著升高,肝组织SOD活性明显降低和MDA含量明显增加(均P<0.01)。结论慢性铝过负荷可致大鼠肝损伤,其机制可能与铝促进氧化应激有关。     

常用肝脏生物化学试验的临床意义及评价共识

肝脏生物化学试验俗称肝功能试验,是判断有无肝脏损害、评估肝病严重程度、追踪肝病进展以及判断治疗效果和预后的重要临床检验指标.常用肝脏生物化学试验主要包括血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、Y-谷氨酰转移酶(GGT)、胆红素(Bil)、白蛋白(Alb)和凝血酶原时间(PT)等项目.     

甲状腺功能亢进症316例肝功能某些指标变化的分析

目的探讨甲状腺功能亢进症（甲亢）患者与肝功能的一些指标变化关系。方法对316例甲亢患者行甲功、肝功能检测,指标包括丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、谷胺酰转肽酶（GGT）、碱性磷酸酶（ALP）、血清总胆红素（TBL）;比较分析甲亢性肝功能损害和甲亢无肝功能损害两组之间的游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺素（TSH）水平;并分析甲亢患者肝功能变化的情况。结果甲亢性肝损害组TSH、FT3、FT4比无肝损害甲亢组高（P〈0．05）,甲亢性肝功能损害时主要以ALP、ALT、AST的异常增高为主;并且FT3、FT4分别与ALP、ALT、AST存在正相关关系,P〈0．05。结论甲亢性肝功能损害（特别是ALP变化）与甲状腺激素水平有密切关系,能否用ALP来协助甲亢诊断和治疗观察值得探讨。     

冠心病患者血清γ-谷氨酰转移酶水平变化及临床意义

目的 研究冠心病患者血清γ-谷氨酰转移酶（GGT）与冠心病严重程度及主要危险因素的关系。方法 对笔者医院888例冠心病患者行冠状动脉造影、超声检查,并检测血清GGT、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)和低密度脂蛋白(LDL-C)水平。结果 与GGT正常组相比,GGT升高组ALT、AST增加,TG上升,HDL-C下降,LVEF下降,Gensini评分升高。且GGT与ALT、AST、TC、TG、LDL-C和Gensini评分呈正相关,与LVEF和HDL-C呈负相关。结论 冠心病患者血清GGT水平与冠心病严重程度及冠心病的主要危险因素有关。     

体外循环心脏停跳和不停跳心内直视手术对机体免疫功能的影响

目的观察体外循环心脏停跳和不停跳心内直视手术对机体免疫功能的影响。方法60例风湿性二尖瓣膜病变患者,随机分为实验组（不停跳组,40例）和对照组（停跳组,20例）,分别于10个时点抽取静脉血,测定T细胞亚群、NK细胞以及IgA、IgG、IgM。结果两组CD3＋、CD4＋、NK细胞以及IgA、IgG、IgM在转机后下降,CD8＋上升,两组比较P≤0.05,实验组CD3＋、CD4＋、CD8＋、NK细胞以及IgA、IgG、IgM恢复较对照组快（P均〈0.05）。结论体外循环不停跳心内直视手术对机体免疫功能影响较心脏停跳者轻。     

Liver enzymes and risk of cardiovascular disease in the general population: A meta-analysis of prospective cohort studies

Background

Gamma glutamyltransferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP), commonly used markers of liver dysfunction, have been implicated with risk of cardiovascular disease (CVD). However, the strength and consistency of their associations in the general population have not been reliably quantified.

Methods

We synthesized available prospective epidemiological data on the associations of baseline levels of GGT, ALT, AST, and ALP with CVD [composite CVD, coronary heart disease (CHD), or stroke outcomes]. Relevant studies were identified in a literature search of MEDLINE, EMBASE, and Web of Science up to December 2013. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using random effects models.

Results

Twenty-nine unique cohort studies with aggregate data on over 1.23 million participants and 20,406 cardiovascular outcomes were included. The pooled fully adjusted RRs (95% CIs) for CVD were 1.23 (1.16–1.29) and 1.08 (1.03–1.14) per 1-standard deviation change in log baseline levels of GGT and ALP levels respectively. There was no evidence of an association of ALT or AST with CVD, however, ALT was somewhat inversely associated with CHD 0.95 (0.90–1.00) and positively associated with stroke 1.01 (1.00–1.02) in stratified analysis. Tests for nonlinearity were suggestive of linear relationships of GGT and ALP levels with CVD risk.

Conclusions

Baseline levels of GGT and ALP are each positively associated with CVD risk and in a log-linear fashion. There may be variations in the associations of ALT with cause-specific cardiovascular endpoints, findings which require further investigation.     

Relationships among viral diagnostic markers and markers of liver function in acute hepatitis E

Background  Diagnosis of acute hepatitis E has been based in many clinics predominantly on detection of anti-HEV (hepatitis E virus) antibody. Now, new assays have been developed to detect other HEV markers. Our aim was to investigate the relationships among HEV diagnostic markers and liver function markers in acute hepatitis E. Methods  Seventy serum samples were collected from non-A, non-B, non-C acute hepatitis patients and tested for HEV markers (HEV antigen and RNA and anti-HEV IgM) and markers of liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total iron binding capacity (TBA), γ-glutamyl transferase (GGT), total bilirubin (TBIL), and direct bilirubin (DBIL)]. Partial open reading frame (ORF) 2 sequences from HEV RNA-positive samples were cloned and analyzed. Results  The concordances between HEV antigen and HEV RNA and between HEV antigen and anti-HEV IgM were 77.1% and 72.9%, respectively, with significant correlations, while that between HEV RNA and anti-HEV IgM was 61.4% with no significant correlation. Eleven of 25 samples negative for anti-HEV IgM were positive for HEV antigen. The ALT, AST, ALP, TBA, GGT, TBIL, and DBIL levels did not differ significantly between the anti-HEV IgM-positive and -negative groups. However, the ALT, AST, ALP, TBA, and GGT levels were significantly higher in the HEV antigen-positive group than in the HEV antigennegative group. All of the HEV isolates cloned belonged to genotype 4. Conclusions  HEV antigen was highly correlated with HEV RNA and elevated ALT, AST, ALP, TBA, and GGT levels. Testing for HEV antigen in combination with anti-HEV IgM is useful for the diagnosis of HEV infection.     

Significant variation of traditional markers of liver injury after a half-marathon run

Background

While the promotion of health-related fitness is thereby widespread, less focus is currently being given on the biological influence that physical activity might exert on results of laboratory testing. As such, this study was undertaken to assess the kinetics of liver injury markers following physical exercise.

Design and methods

Total and direct bilirubin as well as the activity of biochemical markers of liver injury including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), gamma-glutamyl transpeptidase (GGT) and creatine kinase (CK), were measured before and after a half-marathon.

Results

Significant increases occurred for GGT, AST, LDH, CK, total and direct bilirubin immediately after the run. AST, LDH, CK, total and direct bilirubin were still increased 24 h thereafter, whereas GGT decreased after 6 h. None of the athletes exceed the upper reference limit for ALT, ALP and GGT, whereas significant variations were instead observed for LDH, AST, CK, total and direct bilirubin.

Conclusions

Taken together, the results of our prospective investigation clearly attest that an acute bulk of aerobic physical exercise, such as a half-marathon, might produce significant changes in the activity of traditional biomarkers of liver injury, which should be carefully considered when investigating physically active individuals undergoing laboratory testing.     

Characteristics of peripheral blood Gamma-glutamyl transferase in different liver diseases

Gamma-glutamyl transferase (GGT) is a marker of oxidative stress and cholestasis. Because of its low specificity, clinicians usually ignore its diagnostic value.To compare and analyze the clinical features of GGT in primary biliary cholangitis (PBC), drug-induced liver injury (DILI), alcoholic liver disease (ALD), and non-alcoholic fatty liver disease (NAFLD) from the perspective of different causes instead of the severity of the disease.We observed the distribution characteristics and the rate of abnormality of GGT in the above 4 diseases. The relationship between GGT and alanine aminotransferase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), total serum bilirubin, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol was analyzed using Spearman correlation.The highest level of GGT was up to 1000.00 to 2000.00 U/L in PBC and DILI, and the highest level of GGT was more than 2000.00 U/L in ALD, yet the difference was not statistically significant (P > .05). The highest level of GGT was only about 200.00 U/L in NAFLD and was the lowest in 4 liver diseases. Also, GGT was positively correlated with ALP, TC in PBC and DILI. Also, in ALD, GGT was positively correlated with ALT, AST, ALP, TG, and TC. In NAFLD, GGT was positively correlated with ALT, AST, and TG.The abnormal GGT in PBC and cholestasis DILI was associated with cholestasis; in ALD, it was associated with oxidative stress and cholestasis, and in NAFLD, it was associated with oxidative stress. GGT levels had different characteristics in different liver diseases, which were closely related to the pathogenesis of liver diseases.     

e抗原阴性慢性乙型肝炎合并肝脂肪变的预测指标及炎性反应和纤维化诊断

目的 研究HBeAg阴性慢性乙型肝炎(CHB)合并肝脂肪变患者的临床和病理关系,探讨预测此类患者肝组织炎性反应和纤维化的指标.方法 分别收集经临床与病理检查确诊的HBeAg阴性CHB合并和不合并肝脂肪变患者56例和60例,分别研究并比较其空腹血糖(FBG)、空腹血胰岛素(FINS)、三酰甘油(TG)、胆固醇(TC)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、白蛋白(Alb)、球蛋白(Glb)、胰岛素抵抗指数(HOMA-IR)、HBV DNA水平、体重指数(BMI),并就上述指标与肝组织脂肪变、炎性反应和纤维化的关系进行统计学分析.结果 与HBeAg阴性CHB不合并肝脂肪变者相比,合并肝脂肪变患者BMI、FBG、FINS、TG、TC、GGT、ALP、Glb和HOMA-IR明显增高(P值均<0.05),HBV DNA、AST、ALT、Alb明显降低(P值均<0.05),此外炎性反应程度和纤维化程度亦明显增强.可预测HBeAg阴性CHB者是否存在肝脂肪变的参数有BMI,FBG、FINS、TG、TC、GGT和HOMA-IR(P值均<0.05).可预测HBeAg阴性CHB合并肝脂肪变者肝组织是否存在炎性反应的参数有ALT、AST、Glb和HBVDNA(P值均<0.05),可预测其是否存在肝组织纤维化的参数有ALT,AST、Alb、Glb和HBV DNA(P值均<0.05).结论 肝脂肪变在HBeAg阴性CHB患者中较常见,其肝组织脂肪变与BMI、FBG、FINS、TG、TC、GGT和HOMA-IR有关.此类患者除肝脂肪变明显增加外,肝组织炎性反应和纤维化程度亦明显加重.     

e抗原阴性慢性乙型肝炎合并肝脂肪变的预测指标及炎性反应和纤维化诊断

目的 研究HBeAg阴性慢性乙型肝炎(CHB)合并肝脂肪变患者的临床和病理关系,探讨预测此类患者肝组织炎性反应和纤维化的指标.方法 分别收集经临床与病理检查确诊的HBeAg阴性CHB合并和不合并肝脂肪变患者56例和60例,分别研究并比较其空腹血糖(FBG)、空腹血胰岛素(FINS)、三酰甘油(TG)、胆固醇(TC)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、白蛋白(Alb)、球蛋白(Glb)、胰岛素抵抗指数(HOMA-IR)、HBV DNA水平、体重指数(BMI),并就上述指标与肝组织脂肪变、炎性反应和纤维化的关系进行统计学分析.结果 与HBeAg阴性CHB不合并肝脂肪变者相比,合并肝脂肪变患者BMI、FBG、FINS、TG、TC、GGT、ALP、Glb和HOMA-IR明显增高(P值均<0.05),HBV DNA、AST、ALT、Alb明显降低(P值均<0.05),此外炎性反应程度和纤维化程度亦明显增强.可预测HBeAg阴性CHB者是否存在肝脂肪变的参数有BMI,FBG、FINS、TG、TC、GGT和HOMA-IR(P值均<0.05).可预测HBeAg阴性CHB合并肝脂肪变者肝组织是否存在炎性反应的参数有ALT、AST、Glb和HBVDNA(P值均<0.05),可预测其是否存在肝组织纤维化的参数有ALT,AST、Alb、Glb和HBV DNA(P值均<0.05).结论 肝脂肪变在HBeAg阴性CHB患者中较常见,其肝组织脂肪变与BMI、FBG、FINS、TG、TC、GGT和HOMA-IR有关.此类患者除肝脂肪变明显增加外,肝组织炎性反应和纤维化程度亦明显加重.     

临床诊断的肝细胞型急性药物性肝损伤患者血清ALT/ALP比值变化特点与组织病理学特征分析

目的 探讨药物性肝损伤(DILI)患者临床分型的变化及其组织病理学特征。方法 2018年8月～2019年8月入院临床诊断为肝细胞型DILI患者43例,在入院治疗2周后行肝穿活检,在病理学检查当日再次根据临床指标确定临床分型,观察组织病理学特征。结果 43例临床诊断的肝细胞型DILI患者在肝穿时血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)和总胆汁酸(TBA)水平已显著降低,其R值较入院时也显著下降(19.6±13.6对3.29±3.26),差异具有统计学意义(P<0.05);组织病理学检查诊断急性炎症型21例,炎症淤胆型22例;在入院时,急性炎症型与炎症淤胆型患者血清ALT、AST、TBIL、ALP和GGT水平无显著性差异(P>0.05),仅急性炎症型患者R值显著小于炎症淤胆型(13.8±6.2对25.5±16.5,P=0.004),血清TBA水平显著低于炎症淤胆型(61.0±60.8 μmol/L对115.3±80.9μmol/L,P=0.017);入院时诊断为肝细胞型DILI的43例患者在肝穿时仅9例符合肝细胞型临床分型;经ROC曲线分析,以R值等于14.9为截断点,其曲线下面积(AUC)为0.708,具有一定的诊断意义。结论 药物性肝损伤的临床分型会随着病情的变化而呈动态变化,入院时以较高的R值诊断胆汁淤积具有一定的指导意义,值得进一步观察。     

In vivo inefficiency of pentoxifylline and interferon-alpha on hepatic fibrosis in biliary-obstructed rats: assessment by tissue collagen content and prolidase activity

BACKGROUND AND AIM: To evaluate the possible antifibrotic effects of two drugs, pentoxifylline (PTX) and interferon (IFN)-alpha as well as their combination, on a bile-duct-ligated rat hepatic fibrosis model. METHODS: Bile ducts of 34 female Wistar rats were ligated, and 24 bile ducts were sham operated. Bile-duct-ligated rats were divided into four groups, in which either sterile saline, IFN-alpha (100 000 IU/3 days a week), PTX (50 mg/kg/day) or IFN-alpha + PTX were administered. Sham-operated rats were treated at the same doses. On the 28th day, rats were decapitated to obtain blood for the measurements of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT) and bilirubins. Serum prolidase was assayed at the beginning and at the end of the study by the modified Chinard's colorimetric method. Liver prolidase was assayed after tissue homogenization. Liver collagen content was determined by the dye elution method described by Lopez de Leon. Morphometric-densitometric measurements of hepatic fibrosis were quantified by computerized image analysis. RESULTS: The AST, ALT, ALP, GGT and bilirubins, liver prolidase enzyme activity, collagen content and hepatic collagen surface density were found to be increased in bile-duct-ligated rats on day 28. There was no statistically significant recovery or even a change in collagen turnover rate in rats treated with alternate regimens applied in the study (P > 0.05). CONCLUSION: Pentoxifylline, IFN-alpha and their combination have no beneficial effect on experimental fibrosis induced by biliary obstruction.     

黄芪预处理对心脏瓣膜置换术心肌保护作用的临床研究

目的探讨黄芪在心脏瓣膜置换术中对心肌缺血再灌注损伤的保护作用.方法将30例心脏瓣膜置换术患者随机分为试验组和对照组,两组灌注方法及体外循环方法相同.试验组在转机前于预充液中加入黄芪注射液20 ml.分别于主动脉阻断前、开放多时点采血检测心肌酶CK-MB、cTnI的水平;记录两组患者的体外循环时间、主动脉阻断时间及术中、术后各时点血管活性药物多巴胺的用量及心肌收缩能力(dp/dtmax)恢复情况;观察开放后心脏自动复跳率、室性心律失常发生率等心肌电生理指标;电镜观察手术前、后心肌超微结构变化.结果对照组术后室性心律失常发生率、除颤次数明显高于试验组;试验组缺血再灌注后心肌收缩能力(dp/dtmax)恢复情况优于对照组.开放后6 h、12 h血清心肌酶CK-MB水平对照组和试验组分别为(91.6±20.4)U/L和(52.7±17.3)U/L,(148.7±24.2)U/L和(94.3±16.3)U/L;开放后6 h、12 h血清cTnI水平对照组和试验组分别为(4.973±1.431)ng/ml和(2.622±1.024)ng/ml,(5.054±1.419)ng/ml和(1.908±0.984)ng/ml,对照组明显高于试验组(P＜0.05或P＜0.01).试验组心肌超微结构保存较好,损伤较对照组轻.结论黄芪对心脏瓣膜置换术患者心肌缺血再灌注损伤具有明显保护作用.