人工心脏瓣膜置换术围术期心肌损伤生化标志物水平的变化及其意义

目的:探讨人工心脏瓣膜置换患者围手术期心肌损伤生化标志物水平的变化及其临床意义。方法:选择人工心脏瓣膜置换术患者40例,分别检测人工心脏瓣膜置换术前、体外循环结束即刻(ST)及结束后6、24、48、72 h和术后6天肌酸激酶(CK)、肌酸激酶-MB(CK-MB)、心肌肌钙蛋白I(cTnI)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)和β-羟丁酸脱氢酶(HBDH)水平,分析其变化。结果:术前心肌损伤生化标志物中除CRP外均在正常范围内,cTnI和CK-MB在术后6 h增高(P<0.01),天冬氨酸氨基转移酶(AST)、LDH、HBDH于术后24 h增高显著(P<0.01),CRP则于术后48 h达到峰值。血清cTnI与CK-MB两变量间在T_ST~T_6d为正的直线相关关系,和其他标志物比较,相关程度较高。结论:人工心脏瓣膜置换术围手术期心肌损伤生化标志物先后都有异常的变化,监测心肌损伤生化标志物有益于观察病情,减少猝死和其他心脏事件的发生,降低治疗的危险。

Changes and significance of biochemical markers of myocardial damage in the perioperation of heart valve prosthesis replacement

Objective： To investigate the changes and the clinical value of biochemical markers of myocardial damage in patients undergoing operation of heart valve replacement. Methods：The creatine kinase（ CK）, creatine kinase-MB （CK-MB）, cardiac treponin I （ cTnI）, C reactive protein （ CRP）, lactate dehydrogenase （ LDH ） and hydroxybutyrate dehydrogenase （HBDH） in 40 patients receiving heart valve replacement were measured before operation,instantly after extracorporeal circulation, and at 6,24,48,72 hour and 6 days after the operation, and the changes were analyzed. Results： All the biochemical markers of myocardial damage were within normal limits except CRP before operation. The figures of cTnI and CK-MB increased significantly at 6 hour after operation （ P 〈 0.01 ）. Aspartate aminotrans ferase （ AST）, LDH and HBDH rose siguificantly at 24 hour after operation. CRP reached the peak at 48 hour after operation. The two variables of cTnI and CK-MB in serum showed a positive linear correlation and had a higher correlativity comparable to other markers. Conclusions：All the biochemical markers of myocardial damage present abnormal changes successively during the perioperation of cardiac valve replacement. Monitoring the myocardial biochemical markers can decrease sudden death and incidence of other cardiac events.