心肌酶谱和肌红蛋白在早期反映射频消融心肌损伤中的评价

目的：比较肌红蛋白与心肌酶谱在反映心肌损伤中的敏感性，探讨心肌损伤与射频消融能量之间的关系。方法：73例室上性心动过速（室上速）患者分别在血管穿刺术后、心内电生理检查后，射频消融术后即刻和术后第3天检测心肌酶学指标与肌红蛋白，计算各个亚组的消融总能量。结果：射频肖融术后，AST、LDH、HBDH和Mb浓度升高，且以Mb的升高幅度最大，LDH次之，而CK及CK－MB在整体上没有差别。术后第3天，所有指标均恢复到基线水平。LDH、HB－DH和Mb的升高主要表现在右侧旁路组和AVNRT组中，而且血浆水平与各个亚组的射频消融总能量成正比，结论：心肌酶学指标可以反映射频肖融产生的心肌损伤，早期反映射频消融后心肌损伤的指标以肌红蛋白最敏感，LDH次之，然后为HBDH和AST，而CK和CK－MB变化不大；心肌酶学指标的升高程度与消频消融总量成正比，右心消融（右侧旁道和AVNRT）的心肌损伤程度重于左心消融（左侧旁道）。

The evaluation of myocardial enzymes and myoglobin in the early indication of myocardial injury due to radiofrequency ablation

Objective To investigate the sensitivities between the myocardial enzymes and myoglobin on myocardial injury and observed the relationship between myocardial injury and total energy of radiofrequency in the RFCA.Methods 73 patients afflicted with the paroxysmal superventricular tachycardia were enlisted and classified according to the different types.Plasma myocardial enzymes(AST,LDH,HBDH,CK and CKMB) and myoglobin were detected after catheterization,endocardial physiological test,RFCA and 3 days,respectively.The total energy was calculated in each subgroup.Results The plasma levels of AST,LDH,HBDH and myoglobin elevated significantly and immediately after RFCA,especially in the groups of right bypass and AVNRT,and then droped to the baseline after 3 days.Myoglobin shows the greatest elevation magnitude,followed by LDH,HBDH and AST.CK and CKMB didn't fluctuate apparently during the perioperation on the whole,though CK slightly increased in the RFCA of right bypass.The higher the total energy of RFCA,the severer the myocardial injury.Conclusions (1)Plasma myocardial enzymes and myoglobin can indicate the myocardial injury due to RFCA.(2) In the early stage of myocardial injury,myoglobin elevates more sensitively than other myocardial enzymes.(3)Myocardial injury,which is in positive proportion to the total energy of RFCA,is severer in the right ventricular ablation(right bypass and AVNRT) than that in the left ventricular ablation.