非体外与体外循环下冠状动脉旁路移植术病人的心肌酶变化

目的 比较患者在非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB)与体外循环下冠状动脉旁路移植术(on-pump coronary artery bypass grafting,CCABG)围术期心肌酶的变化.方法 择期手术的冠心病患者52例,分为OPCAB组和CCABG组.分别于术前1天,术后1,3,5,8日晨测定血清天冬氨酸转氨酶(glutamic-oxal (o)acetic transaminase,GOT),肌酸激酶(creatine kinase,CK)及心肌型肌酸激酶同工酶MB(MB isoenzyme of creatine kinase,CK-MB),乳酸脱氢酶(lactate dehydrogenase,LDH)及同工酶1(LDH-1).结果 两组择期手术的冠心病患者术前心肌酶的测定结果均在正常范围;术后第1天两组的心肌酶释放达到高峰(P＜0.05),术后第3天均有不同程度的恢复;OPCAB组的所有心肌酶释放量与手术前相比差异无统计学意义(P＞0.05),CCABG组的CK-MB也恢复到手术前水平(P＞0.05),但CCABG组在术后第5天和第8天的LDH和LDH-1仍明显高于术前水平(P＜0.05);两组病人术后第3天的CK-MB恢复到术前水平,但CCABG组其他心肌酶在术后第1天和第3天都明显高于OPCAB组(P＜0.05),CCABG组在术后第5天和第8天的LDH和LDH-1仍明显高于OPCAB的对应值(P＜0.05).结论 OPCAB组的心肌的损伤要轻于CCABG组,表现为心肌酶的释放少而且恢复快.

Comparison of perioperative changes of cardiac enzymes in patients with off-pump or on-pump coronary artery bypass grafting

Objectives To compare the perioperative cardiac enzyme changes in patients with off-pump (OPCAB) or on-pump coronary artery bypass grafting (CCABG). Methods Fifty-two patients were divided into two groups: OPCAB group and CCABG group. The venous blood samples from all patients were taken on the day before operation, postoperative 1st, 3rd, 5th, and 8th days to measure the serum content of AST, CK, CK-MB, LDH and LDH-1. Results All cardiac enzymes measured before operation in two groups were within the normal range. They peaked on the 1st postoperative day(P<0.05). On the 3rd postoperative day all cardiac enzymes in the OPCAB group had recovered to preoperative levels and CK-MB in CCABG group had recovered too(P>0.05), all other cardiac enzymes in the CCABG group were still significantly higher than those preoperative values (P<0.05). On the 5th and 8th postoperative day, LDH and LDH1 in the CCABG group were still significantly higher than their corresponding values measured before operation. Except that CK-MB had recovered on the 3rd postoperative day, all other enzymes were significantly higher in the CCABG group than those in the OPCAB group(P<0.05)on the 1st and 3rd postoperative day. On the 5th and 8th postoperative day LDH and LDH-1 in the CCABG group were still significantly higher than those corresponding values in the OPCAB group (P<0.05). Conclusions OPCAB has less myocardial injury effect than CCABG has, expressed by less release of cardiac enzymes and earlier recovery.