体外循环与非体外循环冠状动脉搭桥术后心电图胸前导联R波振幅变化的差异

目的 探讨体外循环与非体外循环冠状动脉搭桥术后心电图胸前导联R波振幅变化的临床意义。方法 监测38例非体外循环冠状动脉搭桥术后不同时点心电图胸前导联V4、V5的R波振幅的变化，同时测定不同时点的心肌细胞损伤的生物标记物肌酸磷酸激酶同功酶（CK-MB）和肌钙蛋白I（cTnI），并与同时期38例体外循环冠状动脉搭桥术病人进行比较。结果 非体外循环冠状动脉搭桥术后即刻、6、18和24h心电图胸前导联R波电位幅度无明显变化，CK-MB和cTnI也无明显变化，而体外循环冠状动脉搭桥术后相同时间点心电图胸前导联R波振幅明显减小（P〈0．01），CK-MB和cTnI明显增加（P〈0．01）。结论 非体外循环冠状动脉搭桥术比体外循环冠状动脉搭桥术对心肌损伤明显减小。

Difference in the changes of R-wave potentials on the precordial ECG leads in patients after coronary artery bypass graft with or without cardiopulmonary bypass

Objective To study the changes of R-wave potentials on the precordial leads in patients after coronary artery bypass graft(CABG) with or without cardiopulmonary bypass(CBP). Methods Thirty-eight patients undergoing CABG on the beating heart(off-pump group) were analyzed. ECG was recorded at the time of arrival to the intensive care unit, 6,24 and 48h after operation. Simultaneously, CK-MB and cTnI were assayed. A control group of thirty-eight patients undergoing CABG by CBP(on-pump group) was also evaluated. Results The extent of R-wave on precordial leads of surface ECG were significantly reduced,and CK-MB and cTnI were significantly increased in on-pump group than those in off-pump group(P<0.01). However, no statistically significant correlation between the ECG changes and release of myocardial cell damage markers was observed in the two groups. Conclusion The CABG with off-pump group showed astatistically reduction of myocardial cell damage than that with on-pump group.