Jain U
Department of Anesthesia, University of California, San Francisco, CA, USA.
J Cardiothorac Vasc Anesth. 1995 Aug;9(4):389-94. doi: 10.1016/s1053-0770(05)80092-8.
To determine the incidence, triggers, and timing of myocardial injury during reoperation for coronary artery bypass surgery.
Prospective observational.
One tertiary care university hospital.
15 patients undergoing reoperation.
Multilead electrocardiographic monitoring approximately every 3 minutes during surgery.
The occurrence of a new ischemic ST elevation or depression on the electrocardiogram (ECG) was determined. A major deterioration in ventricular function after cardiopulmonary bypass (CPB) also was determined. Peak creatine kinase myocardial band (CK-MB) > or = 25 IU/L was considered to be the marker of myocardial injury. Seven patients demonstrated myocardial injury, all intraoperatively. Five of these patients had new ST elevation episodes before CPB. Three of the episodes were temporally associated with an abrupt increase in the heart rate. The other two episodes were temporally associated with surgical manipulation of the heart and the old grafts. The sixth patient had a significant deterioration of ventricular function during CPB. One of the patients who had ST elevation before CPB and the seventh patient developed ST elevation towards the end of protamine administration.
In patients undergoing reoperation, the intraoperative incidence of myocardial injury, especially before CPB, was found to be substantially higher than that previously reported.
确定冠状动脉搭桥手术再次手术期间心肌损伤的发生率、触发因素及发生时间。
前瞻性观察研究。
一家三级护理大学医院。
15例接受再次手术的患者。
手术期间约每3分钟进行多导联心电图监测。
确定心电图（ECG）上新发缺血性ST段抬高或压低的发生情况。同时确定体外循环（CPB）后心室功能的严重恶化情况。肌酸激酶同工酶（CK-MB）峰值>或=25 IU/L被视为心肌损伤的标志物。7例患者出现心肌损伤，均发生在术中。其中5例患者在CPB前出现新发ST段抬高发作。其中3次发作在时间上与心率突然增加有关。另外2次发作在时间上与心脏及旧移植血管的手术操作有关。第6例患者在CPB期间心室功能显著恶化。1例在CPB前出现ST段抬高的患者及第7例患者在鱼精蛋白给药接近尾声时出现ST段抬高。
在接受再次手术的患者中，发现心肌损伤的术中发生率，尤其是在CPB前，显著高于先前报道的发生率。
