Contini G A, Astorri E, Gavaruzzi G, Campodonico R, Albertini D, Reverberi C, Antonelli A M, Fesani F
Cattedra di Cardiochirurgia, Università degli Studi, Parma.
Cardiologia. 1992 Nov;37(11):797-800.
To evaluate myocardial damage induced by coronary bypass surgery, to construct a reference data set in postoperative patients and to ascertain the impact of perioperative myocardial infarction on myosin release from sarcolemmal membrane we serially measured levels of serum fragments of myosin heavy chains by means of monoclonal antibody immunoradiometric assay (MYOSIN IRMA ERIA Pasteur). After surgery serum levels of myosin increased from third postoperative day and peaked on seventh day. Peak myosin levels did correlate with enzymatic activities of CPK (r = 0.69; p < 0.001) and of CPK-MB (r = 0.75; p < 0.001). Six patients suffered postoperative myocardial infarction: in these patients myosin levels were significantly different from those without infarctions (3651 +/- 1569 versus 699 +/- 206 ng/ml; p < 0.01). No correlation could be demonstrated between cardiopulmonary bypass time or aortic cross clamp duration. The rise of myosin levels observed in nearly all patients suggests a minor intraoperative damage to the contractile apparatus that sometimes is diagnosed as myocardial infarction and often does not meet clinical diagnostic criteria.
为评估冠状动脉搭桥手术引起的心肌损伤，构建术后患者的参考数据集，并确定围手术期心肌梗死对肌球蛋白从肌膜释放的影响，我们通过单克隆抗体免疫放射分析（肌球蛋白免疫放射分析酶免疫测定法，巴斯德公司）连续测量血清肌球蛋白重链片段水平。术后血清肌球蛋白水平从术后第三天开始升高，并在第七天达到峰值。肌球蛋白峰值水平与肌酸磷酸激酶（CPK）（r = 0.69；p < 0.001）和肌酸磷酸激酶同工酶MB（CPK-MB）（r = 0.75；p < 0.001）的酶活性相关。六名患者发生术后心肌梗死：在这些患者中，肌球蛋白水平与无梗死患者的水平有显著差异（3651±1569对699±206 ng/ml；p < 0.01）。未发现体外循环时间或主动脉阻断时间与之有相关性。几乎所有患者中观察到的肌球蛋白水平升高表明术中对收缩装置有轻微损伤，这种损伤有时被诊断为心肌梗死，且常常不符合临床诊断标准。
