心脏瓣膜替换术中相关因素对心肌酶谱的影响

目的　探讨心脏瓣膜替换术中相关因素对心肌细胞的损害 ,为良好的心肌保护措施提供客观依据。方法　随机法取二尖瓣替换术 16例、主动脉瓣替换术 8例、二尖瓣加主动脉瓣替换术 12例 ,分别于停机时、术后 2 0h、44h、6 8h、116h抽血测定肌酸激酶 (CK)、肌酸激酶同功酶 (CK -MB)、乳酸脱氢酶(LDH) ,观察主动脉阻断时间长短、心脏停跳液用量、心脏复跳情况对心肌酶的影响。结果　 (1)随主动脉阻断时间的延长 ,CK、CK -MB、LDH呈进行性增高。在停机时及术后 2 0h ,主动脉阻断时间 <30min组与>6 0min组相比有显著差异 (P <0 .0 5 ) ;(2 )心脏停跳液用量 <15ml·kg- 1 组与 >2 0ml·kg- 1 组相比 ,停机时CK、CK -MB、LDH均有显著性差异 (P <0 .0 1,P <0 .0 5 ) ;(3)电除颤复跳与自动复跳组各时间均无明显差异 (P >0 .0 5 )。结论　主动脉阻断时间过长、心脏停跳液用量不足、手术创伤是引起心肌细胞损害的主要因素。

Effects of relative factors in operation of valve replacement on my ocardial enzymogram

Objective To investigate effecting factors of cardiac valve replacement on injury of myocardium cell and provide the objective basis for myocardium preservation. Methods The activities of CK, CK-MB, LDH were measured at the time of stopping, 20h, 44h, 68h,116h after operation respectively in 36 patients with cardiac valve replacement including MVR 16,AVR 8 and DVR12 patients.The affects of the clamping time of the aortic arch,the dose of cardioplegia solution,and the automatic heart rebeating on myocardiac enzymoram were observed. Results The CK, CK-MB, LDH, increased along with time of aorta clamping. There was significant difference between aorta clamping <30min and >30 min at the time of bypass stopping and 20h after operation(P<0.05).There was significant difference between the carcioplegia solution <15ml·kg -1 and >20ml·kg -1 ,at bypass stopping(P<0.05) 20h after operation (P<0.01).The myocardium enzymes was not deference whether the heart automatic rebeating or not. Conclusion Too long time of aorta clamping, the cardioplegia solution not enough, and surgery tradma in operation are the main factors of heart cell injury.