The Changes Of Perioperative Myocardial Enzymmes And Activity Ratios Undergoing Open Heart Surgery During Coronary Pulmonary Bypass

Objective: To investigate the perioperative changes of serumcreating kinase(CK) .creatine kinase isoenzymeE(CK-MB), lacate dehydrogenae (LDH), aspartate transaminase(AST), a-Hydroxybutyrate dehydrogenase( a-HBDH)and the activity ratios of CK-MB/kand a -HBDH/LDH and their efficacy in diagnosing myocardial injury after open heart surgery.Methods: On the preoperative day and the 1, 2, 3, 4, Sand the 6th day after the operation, the heparin-serum was taken to measure the release of myocardial enzymes in 20 patients. In all patients' , twelve-lead electrocardiogrms' recordings were obtained preoperatively and on the 1hour, 1, 2, 3, 5, 7th postoperative day. 10 patients were coronary arterybypass grafting(CABG) and the other were cor genital heart disease(CHD).Result:All the myocardial enzymes and activity ratios measuredbefore the operation were in the normal range.Their release increased abruptly on the 1 hour postoperatively to 2-40 times of before operation (P<0. 05). The activity ratios of CK-MB/Ck and a-HBDH/LDH was more than the normal range and the release of postoperative myocardial enzymes in two group is unevident diversity(P>0.05). But the myocardial enzymes ofCHD group were little higher than that of CABG group, they recovered more rapidly.Conclusion: All the myocardial enzymes and activity ratiosmeasured before the operation were in the normal range. CK-MB increased peak the first hour postoperatively, it recovered after 3 day, followed by AST and CK, LDH and a-HBDH have not recovered on the 6th postoperative day, the releasing peak time and recovering sequence of postoperative myocardial enzymes in two groups is the same . The changes of postoperative maocardial enzymes can microcosmicly reflect myocardial damage and recovery .The myocardial injury after operation is reversible.The postoperative myocardial enzymes which go up more than 5 timees can not still diagnosis perioperative myocardial infartion(PMI). The change of serum CK-MB and CK' s activity in patients with open heart surgery undergoing coronary pulmonary bypass may be more sensitive and specific to the forepart diagnosis of perioperat ve myocardial injury and infarction, the elevatory range of AST is related to the degree of myocardial injury. The change of serum LDH and a-HBDH shoud be used to evaluate the recovery of myocardium ischemie and reperfusion injury, and they apply in retrospective diagnosis. The pcstoperative activity ratios of serum CK-MB/CK and a -HBDH/LDH may no reflect on the degree of perioperative myocardial injury.