血液停跳液与晶体停跳液对冠状动脉搭桥术患者术中心肌保护的比较

目的比较血液停跳液和晶体停跳液对冠心病(CAD)患者冠状动脉搭桥术中心肌保护的效果,探讨损伤心肌恢复的指标。方法将53例择期手术的CAD患者分为两组:血液停跳液组(B-CAD)和晶体停跳液组(C-CAD)。分别于术前1d,术后1、3、5、8d晨取静脉血,测定血清天冬氨酸转氨酶(AST)、磷酸肌酸激酶及同功酶M(BCK,CK-MB)、乳酸脱氢酶及同功酶(1LDH,LDH-1)。结果两组患者术前心肌酶的测定结果均在正常范围,术后1d两组的心肌酶释放达到高峰(P<0.05),术后3d均有不同程度的恢复,两组的CKMB已恢复到正常值,C-CAD组的AST与术前相比已无明显差别(P>0.05),但两组的其他心肌酶仍明显高于术前水平(P<0.05)。术后5d继续恢复,两组的CK也恢复到正常水平,但两组的LDH和LDH-1在术后5d和术后8d仍高于术前水平(P<0.05)。术后1d、3dB-CAD的LDH和LDH-1以及术后5dB-CAD的LDH均明显高于C-CAD的测定值(P<0.05),两组间其他心肌酶值在不同的时间差异无统计学意义。以术前心肌酶的值对术后心肌酶值进行校正后,两组间心肌酶的释放在术后各个测定点差异均无统计学意义。心肌酶的释放与主动脉阻断时间(CCT)和体外循环时间(ECCT)呈良好的正相关。两组患者的年龄、体重、CCT和ECCT差别无统计学意义(P>0.05)。结论从心肌酶的释放来判断,血液停跳液并不优于晶体停跳液对CAD的心肌保护效果。要判断心肌损伤的恢复,应以LDH和LDH-1的恢复为标准。

The comparison of blood cardioplegia and crystalloid cardioplegia on myocardial protection for coronary artery bypass grafting patients

Objective To compare the effects of myocardial protection between blood and crystalloid cardioplegia for coronary artery bypass grafting patients. Methods Divide 53 patients into two groups: blood cardioplegia group(B-CAD) and crystalloid cardioplegia group (C-CAD). The venous blood samples from all patients were taken on the day before operation, postoperative 1,3,5,and 8 days to measure the serum content of AST,CK, CK-MB, LDH and LDH-1. Results All cardiac enzymes measured before operation in two groups were within the normal range. They peaked on the 1st postoperative day (P<0.05). On the 3rd postoperative day AST in C-CAD group and CKMB in two groups had recovered to preoperative level(P>0.05), all other cardiac enzymes in two groups were still significantly higher than those preoperative values (P<0.05). CK in both groups also recovered to the normal level on the 5th day postoperatively, but LDH and LDH1 did not recover. On the 8th postoperative day,LDH and LDH-1 in both groups were still significantly higher than their corresponding values measured before operation. Except that LDH and LDH-1 on the 1st and 3rd, LDH on the 5th postoperative day were significantly higher in B-CAD group, there were no statistical differences between two groups for all other enzymes measured at any time. If we corrected postoperative release of all cardiac enzymes with their preoperative corresponding values we could not find any statistical differences for all enzymes released postoperatively between two groups. There were no significant differences between two groups for age, body weight,CCT and ECCT. We also found that the release of myocardial enzymes was positively correlated with the aortic cross-clamping time (CCT) and extracorporeal circulation time (ECCT). Conclusion According to the release of 5 cardiac enzymes, blood cardioplegia is not superior to crystalloid cardioplegia in the myocardial protection for coronary artery bypass grafting patients. LDH and LDH-1 should be used to evaluate the recovery of myocardium after ischemic and reperfusion injury.