冠状动脉架桥术患者围术期心肌酶的动态变化

目的 :连续对 14例择期手术的冠状动脉架桥术 (CABG)患者围术期心肌酶的变化进行了动态观察 ,旨在更全面了解心肌在术中受缺血影响的程度和恢复的情况 ,进一步揭示CABG患者心肌酶围术期变化的规律 ,为临床治疗提供依据。方法 :14例CABG患者术前 1d ,术后 1,3,5 ,8d晨分别取静脉血 ,测定血清谷草转氨酶 (AST) ,磷酸肌酸激酶及同功酶MB(CK ,CK-MB) ,乳酸脱氢酶及同功酶 1(LDH ,LDH - 1)。结果 :择期手术的CABG患者术前 5种心肌酶均在正常范围 ,术后 1d分别升高到术前的 3- 11倍 (P <0 .0 5 ) ;术后 3d均有不同程度的恢复 ,CK -MB已恢复到正常范围 ,AST已与术前值无明显差别虽说它仍高于正常值 ,其他 3种酶仍显著高于术前水平 (P <0 .0 5 ) ;术后 5d继续恢复 ,LDH和LDH - 1仍高于术前水平 (P <0 .0 5 ) ,CK也已恢复到正常水平 ,AST虽仍略高于正常水平 ,但是其与术前测定值相比无差别 (P >0 .0 5 ) ;术后 8dAST也恢复到正常水平 ,但LDH与LDH - 1仍未恢复正常 (P <0 .0 5 )。结论 :择期手术的CABG患者术前 5种心肌酶均在正常范围 ;这些心肌酶的释放术后 1d达最高峰 ,CK -MB恢复最快 ,CK与AST次之 ,LDH和LDH - 1最慢 ,术后 8d仍明显高于术前水平 ;要判断心肌损伤的恢复应以LDH和LDH - 1的恢复为标准。

Perioperative Changes of Myocardial Enzymes Among Coronary Artery Bypass Grafting Patients

Objective: To evaluate the extent of myocardial injury during operation and the recovery postoperatively and to disclose the pattern of perioperative cardiac enzyme changes among coronary artery bypass grafting patients. Method: The venous blood samples from 14 patients of coronary artery bypass grafting were taken on the day before operation, postoperative day 1, 3, 5, and 8 to measure the serum leveles of AST, CK, CK-MB, LDH and LDH-1. Results: The values of AST, CK, CK-MB, LDH and LDH-1 before operation were within the normal range. On the 1 st postoperative day, they peaked to three to eleven times of those values preoperatively ( P <0.05). CK, LDH and LDH-1 were still significantly higher than those preoperative values ( P <0.05) although CK-MB had recovered to the normal range and AST had no significant difference with its corresponding value preoperatively on the 3 rd postoperative day. CK recovered to the normal range on the 5 th postoperative day. On the 8 th postoperative day, AST recovered to the normal range, too, while LDH and LDH-1 were still significantly higher than their corresponding values measured before operation. Conclusion: The 5 cardiac enzymes measured before operation are all within the normal range. CK-MB recovered first postoperatively, followed by CK and AST; LDH and LDH-1 have not recovered on the 8 th postoperative day, therefore LDH and LDH-1 should be used to evaluate the recovery of myocardium after ischemic and reperfusion injury.