Adoumie R, Lockanathan R, Yen A, Chiu R C
Division of Cardiothoracic Surgery, McGill University, Montreal General Hospital, Que.
Can J Surg. 1994 Jun;37(3):203-7.
To determine whether the independently observed increase in the levels of cardiac enzymes in peripheral blood can be accounted for by elevations from postoperative shed-blood reinfusion in patients who have undergone cardiac or thoracic operations.
Prospective, case-controlled study.
A cardiothoracic surgery unit at a university referral centre.
Thirty-four consecutive patients who underwent cardiac or thoracic surgery within a 3-week period.
Coronary artery revascularization (23 patients), cardiac valve replacement or repair (4) and lung resection (7).
Determination of levels of cardiac enzymes and isoenzymes in samples of peripheral and shed blood. Statistical comparison was by paired t-tests within groups and by unpaired t-tests between groups.
Serum levels of creatine kinase, lactic dehydrogenase and aspartate aminotransferase were significantly (p < 0.001) elevated in samples of shed blood compared with peripheral blood in all groups. The elevations were found to be related to skeletal muscle injury and were not of cardiac origin. In the absence of myocardial infarction, cardiac isoenzyme levels were significantly (p < 0.001) elevated in the peripheral blood of cardiac surgery patients compared with that of thoracic surgery patients.
Reinfusion of shed blood will result in elevated levels of cardiac enzymes in peripheral blood but will not increase the percentage of isoenzymes.
确定在接受心脏或胸部手术的患者中，外周血中心脏酶水平独立观察到的升高是否可由术后回输 shed 血（术野失血）导致。
前瞻性病例对照研究。
一所大学转诊中心的心胸外科病房。
在 3 周内连续接受心脏或胸部手术的 34 例患者。
冠状动脉血运重建（23 例患者）、心脏瓣膜置换或修复（4 例）和肺切除术（7 例）。
测定外周血和 shed 血样本中心脏酶和同工酶的水平。组内采用配对 t 检验，组间采用非配对 t 检验进行统计学比较。
与外周血相比，所有组的 shed 血样本中肌酸激酶、乳酸脱氢酶和天冬氨酸转氨酶的血清水平均显著升高（p < 0.001）。发现这些升高与骨骼肌损伤有关，而非心脏来源。在无心肌梗死的情况下，心脏手术患者外周血中的心脏同工酶水平与胸外科手术患者相比显著升高（p < 0.001）。
回输 shed 血会导致外周血中心脏酶水平升高，但不会增加同工酶的百分比。
