Detection of myocardial injury after coronary artery bypass grafting using a hypothermic, cardioplegic technique.
Detection of myocardial injury after coronary artery bypass grafting using a hypothermic, cardioplegic technique.
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使用低温心脏停搏技术检测冠状动脉旁路移植术后的心肌损伤。
DOI：
10.1016/s0003-4975(10)61899-1
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发表时间：
1982
影响因子：
4.6
通讯作者：
W. Lell
中科院分区：
文献类型：
--
作者：
H. Mcdaniel;J. Reves;N. Kouchoukos;L. Smith;W. Rogers;P. Samuelson;W. Lell
通过连续血浆肌酸激酶- mb同工酶（CK-MB）测定和心电图，对50例接受隔离冠状动脉旁路移植术的患者进行心肌损伤评估。41例（82%）患者有三支血管病变。术前血管造影检查左心室收缩力正常13例（26%），轻度异常26例（52%），中度或重度异常11例（22%）。移植动脉数为2 ~ 6条（平均3.5条）。主动脉夹持时间平均为38.6±1.6分钟。没有医院死亡病例。1例患者出现心肌梗死的酶和心电图证据。16例（32%）患者发生非特异性心电图改变，其余33例（66%）患者心电图无变化。49例无心电图梗死证据的患者，体外循环开始后6 h的平均血浆CK-MB峰值为7.9±0.8 IU/L（平均值标准误差），平均综合面积为158±19.5 IU/L × h。这些CK-MB值与疾病程度、移植动脉数或心肌缺血持续时间无相关性。这些数据表明该技术术中心肌损伤发生率低，可以作为与其他术中心肌保护技术比较的基线。
Fifty patients undergoing isolated coronary artery bypass grafting procedures using a clear, cold cardioplegic solution, topical hypothermia, and reduced systemic flow for intraoperative myocardial protection were evaluated for myocardial injury by serial plasma creatine kinase–MB isoenzyme (CK-MB) measurements and electrocardiograms. Forty-one (82%) of the patients had three-vessel disease. Preoperative left ventricular contractility determined angiographically was normal in 13 patients (26%), mildly abnormal in 26 (52%), and moderately or severely abnormal in 11 (22%). The number of arteries grafted ranged from 2 to 6 (mean, 3.5). The mean duration of aortic clamping was 38.6 ± 1.6 minutes. There were no hospital deaths. Enzymatic and electrocardiographic (ECG) evidence of myocardial infarction occurred in 1 patient. Nonspecific ECG changes occurred in 16 patients (32%), and the electrocardiograms were unchanged in the remaining 33 patients (66%). In the 49 patients without ECG evidence of infarction, the mean peak plasma CK-MB value, which occurred 6 hours after the onset of cardiopulmonary bypass, was 7.9 ± 0.8 IU/L (standard error of the mean) and the mean integrated area 158 ± 19.5 IU/L × hours. There was no correlation between these CK-MB values and the extent of disease, number of arteries grafted, or the duration of myocardial ischemia. These data document a low incidence of perioperative myocardial injury with this technique, and can serve as a baseline for comparison with other techniques for intraoperative myocardial protection in this setting.