Vaagenes P, Kjekshus J, Sivertsen E, Semb G
Crit Care Med. 1987 Aug;15(8):726-31. doi: 10.1097/00003246-198708000-00003.
We serially measured creatine kinase (CK), lactate dehydrogenase, aspartate aminotransferase (AST) and lactate from the lumbar cerebrospinal fluid in 14 patients with neurologic complications after open heart surgery with cardiopulmonary bypass (CPB). These analyses revealed a correlation between worsening neurologic deficit and the peak CK (r = .87, p less than .001), AST (r = .75, p less than .01), and lactate (r = .93, p less than .001) levels. Lactate increased before enzymes did. In 12 patients without complications, only lactate was significantly (p less than .005) elevated; however, within this group, CK but not lactate could be used to differentiate patients who later developed subtle mental changes. Although CPB appeared to induce metabolic changes in the brain that could possibly disturb function, severe cerebral damage appeared to require additional global or focal anoxic-ischemic factors. Short hypothermia during bypass did not influence CK, but it was falsely elevated after prolonged hypothermic periods. The testing of these enzymes may be a reliable indicator of the degree of brain damage and the prognosis.
我们连续测量了14例体外循环心脏直视手术后出现神经并发症患者的腰椎脑脊液中的肌酸激酶（CK）、乳酸脱氢酶、天冬氨酸转氨酶（AST）和乳酸水平。这些分析显示，神经功能缺损加重与CK峰值（r = 0.87，p < 0.001）、AST（r = 0.75，p < 0.01）和乳酸（r = 0.93，p < 0.001）水平之间存在相关性。乳酸比酶升高得更早。在12例无并发症的患者中，仅乳酸水平显著升高（p < 0.005）；然而，在该组中，CK而非乳酸可用于区分后来出现轻微精神变化的患者。尽管体外循环似乎会在大脑中引发可能干扰功能的代谢变化，但严重的脑损伤似乎还需要其他全身性或局灶性缺氧缺血因素。体外循环期间的短期低温并未影响CK，但在长时间低温期后CK会出现假性升高。这些酶的检测可能是脑损伤程度和预后的可靠指标。
