摘要
目的探讨体外循环冠状动脉旁路移植术（CABG）与非体外循环冠状动脉旁路移植术（OPCABG）后ECG及心肌损伤标志物变化的临床意义。方法监测25例冠心病患者OPCABG术后（OPCABG组）不同时间点ECG V4、V5导联的R波振幅的变化，同时测定不同时间点的肌酸磷酸激酶同功酶MB（CPK—MB）、肌钙蛋白I（cTnI）和热休克蛋白70（HSP70）水平，并与同时期25例行体外循环CABG的冠心病患者（CABG组）进行比较。结果OPCABG组术后0．6、18、24h ECG V4、V5导联R波振幅与术前比较差异无统计学意义，而CABG组术后0、6、18h ECG V4、V5导联R波振幅较术前明显下降（P〈0．01），24hR波振幅逐渐恢复至术前水平；CABG组CPK—MB和cTnI水平在术后24h达到峰值，且中位峰值水平明显高于OPCABG组（29．29 μg／L比5．98 μg／L，6．74 μg/L比1．91 μg／L）。两组的HSP70水平在术后6h皆达到峰值，但CABG组中位峰值水平显著高于OPCABG组（11044．5 pmol／L比1702．0 pmol／L）。在术后第1天HSP70水平与CPK—MB（r=0．370，P〈0．01）、cTnI（r=0．458，P〈0．01）存在相关性。结论OPCABG与体外循环CABG比较，对心肌损伤明显减小，HSP70水平能提示心肌细胞的损伤程度。
Objective To investigate the clinical significance of the changes of electrocardiogram （ECG） and cardiac markers for myocardial damage after on-pump coronary artery bypass grafting （CABG） and off-pump coronary artery bypass grafting （OPCABG）. Method Monitoring 25 patients of OPCABG （OPCABG group） and 25 patients of CABG （CABG group） R wave amplitude of V4 and V5 on anterior elec- trocardiographic lead and simultaneously determining cardiac markers for myocardial damage creatine phosphokinase isoenzyme MB （CPK-MB）, troponin I （eTnI） and heat-shock protein 70 （HSP70） on different time. Results R wave amplitude of V4 and V5 on anterior electrocardiographic lead had no significant changes on 0, 6, 18 and 24 hours after OPCABG. On the contrary, R wave amplitude of V4 and V5 on anterior electrocardiographic lead decreased significantly on 0, 6 and 18 hours after CABG （P 〈 0.01 ）, and came back to preoperative values 24 hours after operation. The levels of CPK-MB and eTnI reached its peak and higher significantly for CABG than those for OPCABG on 24 hours after operation, 29.29 μg/L vs 5.98 μ g/L and 6.74 μg/L vs 1.91 μg/L respectively. HSP70 increased significantly on 6 hours after operation in two groups, but median of HSP70 was higher significantly in CABG group （ 11044.5 pmol/L vs1702.0 pmol/L）. In the first clay after operation the HSP70 peak was correlated significantly with the level of CPK-MB（r = 0.370, P 〈0.01 ） and cTnI （r = 0.458,P 〈0.01 ）. Conclusions Myocardial damage is significantly alleviated for patients of OPCABG comparing with those of CABG. The HSP70 in circulation may indicate the degree of myocardial damage.
出处
《中国医师进修杂志》
2008年第7期14-17,共4页
Chinese Journal of Postgraduates of Medicine
