激光心肌血运重建术患者围手术期心肌酶变化及其影响因素

目的分析激光心肌血运重建术(TMLR)患者围手术期心肌酶变化规律和影响因素。方法采用速率法测定103例TMLR患者围手术期心肌酶,观察其变化趋势,统计TMLR术后心肌酶正常上限参考值,分析可能影响术后心肌酶变化的因素。结果CK-MB于术后第1天达峰值,与术前比较差异有显著意义,随后下降,至术后第2天已基本恢复到术前水平;本研究统计出TMLR术后心肌酶的正常上限参考值;在诸多影响因素中,心功能低下(EF<40%)者CK-MB于术后第2～4天明显升高。结论TMLR术后当天至术后第5天,CK-MB的正常上限参考值分别是55、138、112、41、35、17IU/L。术前心功能低下是影响TMLR术后心肌酶改变的主要因素之一。

Changes and Effective Factors in Myocardial Enzymes of 103 Patients Underwent Transmyocardial Laser Revascularization

Objective The relationship between the changes in myocardial enzymes and their effective factors after transmyocardial laser revascularization (TMLR) was analyzed for preventing postoperative complications. Methods Myocardial enzymes were measured by the speed method in 103 patients before TMLR and from the 1st day to the 5th day postoperatively. The superior values of myocardial enzymes were analyzed on the basis of 87 cases without postoperative myocardial infarction,and possible factors which affected the change in myocardial enzymes were analyzed in all cases. Results Creatine phosphokinase isoenzyme MB (CK MB) had reached to peak at the 1st day postoperatively which was different significantly comparing with the baseline,then descended gradually,and was going on normal at the 2nd day postoperatively.The superior values of myocardial enzymes post TMLR was analyzed.According to the analysis of possibly effective factors, CK MB was increased significantly in the patients with lower ejection fraction (EF<40%) from the 2nd to 4th day after TMLR. Conclusions The superior limited values of CK MB are 55,138,112,41,35,17 IU/L,respectively during the six days post TMLR.There is a signifficant relationship between lower ejection fraction (EF<40%) preoperatively and the changes in myocardial enzymes postoperatively.