Nguyen D M, Gilfix B M, Dennis F, Blank D, Latter D A, Ergina P L, Morin J E, de Varennes B
Division of Cardiothoracic Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada.
Ann Thorac Surg. 1996 Jul;62(1):109-14. doi: 10.1016/0003-4975(96)00222-6.
Infusion of shed mediastinal blood using an autotransfusion system is a widely applied technique of blood conservation in cardiac surgery. Serial determinations of serum creatine kinase (CK), its MB isoenzyme (CK-MB), and lactate hydrogenase (LDH) levels have been used to monitor perioperative myocardial injury. We investigated the impact of postoperative autotransfused blood infusion on serum levels of these enzymes.
We performed a retrospective analysis of postoperative serum CK, CK-MB, and LDH levels of 300 patients who had elective uncomplicated aortocoronary bypass grafting. Shed mediastinal blood samples from 26 patients were analyzed for CK, CK-MB (enzymatic activity and mass), and LDH levels before infusion.
High postoperative serum levels of CK and LDH were observed after infusion of autotransfused blood. Shed mediastinal blood contained extremely high levels of these enzymes, particularly from patients who had internal mammary artery dissection. There was a strong correlation (r = 0.96) between measured CK-MB enzyme activities and those calculated from the CK-MB mass units.
Infusion of autotransfused blood containing high concentrations of CK and LDH results in elevated serum levels of these enzymes. Hemolysis, frequently present in shed blood, does not interfere with the routine biochemical assays for CK and CK-MB enzyme activities. Caution should be taken when postoperative cardiac enzyme levels are used to determine myocardial injury after aortocoronary bypass grafting if autotransfusion is used as a method of blood conservation.
使用自体输血系统输注纵隔引流血是心脏手术中广泛应用的一种血液保护技术。连续测定血清肌酸激酶（CK）、其MB同工酶（CK-MB）和乳酸脱氢酶（LDH）水平已被用于监测围手术期心肌损伤。我们研究了术后自体输血对这些酶血清水平的影响。
我们对300例行择期单纯主动脉冠状动脉搭桥术患者的术后血清CK、CK-MB和LDH水平进行了回顾性分析。对26例患者的纵隔引流血样本在输注前进行CK、CK-MB（酶活性和质量）和LDH水平分析。
输注自体输血后观察到术后血清CK和LDH水平升高。纵隔引流血中这些酶的含量极高，尤其是来自有乳内动脉解剖的患者。测得的CK-MB酶活性与根据CK-MB质量单位计算的活性之间存在很强的相关性（r = 0.96）。
输注含有高浓度CK和LDH的自体输血会导致这些酶的血清水平升高。溶血在引流血中经常出现，但不干扰CK和CK-MB酶活性的常规生化检测。如果使用自体输血作为一种血液保护方法，在主动脉冠状动脉搭桥术后使用心脏酶水平来确定心肌损伤时应谨慎。
