Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Changes of Plasma Creatinine Kinase-BB after Total Circulatory Arrest

총순환정지후 혈중 크레아티닌 카이네이즈 BB의 변화에 관한 연구

  • 이석재 (충북대학교 의과대학 흉부외과학교실) ;
  • 김용진 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 김오곤 (충북대학교 의과대학 흉부외과학교실)
  • Published : 1998.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Although profound hypothermia with total circulatory arrest(TCA) is a valuable maneuver in cardiac surgery, its applications have been limited due to serious complications, especially cerebral damage. In this study, the possible role of creatinine kinase-BB(CK-BB), an index enzyme of ischemic cerebral damage, was assayed as a parameter for the assessment of the cerebral complications after TCA. Hemoglobin(Hb), ionized calcium(Ca++), and blood glucose levels were also assessed as clinical parameters involved in cerebral damage. Materials and methods: Among patients with congenital heart disease, 18 patients who had been operated on with TCA were randomly selected and divided into two groups: 6 with acyanotic and 12 with cyanotic heart disease. Arterial blood from each patient was collected before and after TCA at scheduled times(15 min., 30 min, 1, 2, 4, 8, and 12hr). The levels of CK-BB, Hb, Ca++, and blood glucose were assessed in each sample. Results: As a whole, correlation between CK-BB level and blood sampling time after TCA was not statistically significant. Also, the difference in the level of CK-BB after TCA was not significant between the acyanotic and cyanotic groups. The levels of Hb and CK-BB correlated significantly. Conclusions: The results, which showed no correlation between the alterations in CK-BB level and the TCA duration, suggest that the single assay of the CK-BB level is not a representative measurement for the assessment of cerebral damage after TCA. Also, the cyanotic congenital heart disease group is not more vulnerable to cerebral damage induced by TCA.

개심술시 총순환정지는 매우 유용한 방법이나 뇌손상등 부작용으로 그 사용이 제한되고 있다. 이러한 뇌손상의 분석에 유용한 지표로서 뇌 허혈성 손상의 특이한 효소인 크레아티닌 카이네이즈 BB(CK-BB)의 유용성을 재고하고 뇌손상에 영향을 미치는 인자들의 분석을 시도하였다. 총순환정지를 이용하여 개심술을 시행한 18명의 환자를 대상으로 하였다. 이들은 다시 비청색증형 심기 형군과 청색증형 심기형군으로 나누어 각각 6명과 12명으로 하였다. 각 환자에서 총순환정지전 및 후 15, 30, 60, 120, 240, 480, 720분에 동맥혈을 채취하여 CK-BB분획을 측정하였고 이와 동시에 혈색소농도, 이 온화 칼슘농도, 혈당량 등을 측정하였다. 총순환정지시간과 CK-BB와 통계적으로 유의한 관계를 보이는 채혈시간은 찾을 수 없었다. 또 총순환 정지전의 문제로 인한 영향을 줄이기 위하여 각각의 측정치에서 총순환정지전의 측정치를 뺀 값을 구하 여 각기 CKBBD15, CKBBD30....등으로 표시하고 상관관계를 구하였으나 역시 유의한 상관관계를 보이 지 않았다. CKBB30과 CKBBD30값은 비청색증형 군과 청색증형 군 사이에 유의한 차이를 보이지 않았 다. CK-BB농도와 혈색소 농도는 유의한 상관관계를 보였다. 단일 채혈에 의한 CK-BB농도의 지표는 순환정지시간과 유의한 관계가 없음이 확인되었다. 또한 청색 증형 심질환군이 총순환정지에 의한 뇌손상에 비청색증형 심질환군에 비해 더 취약하지는 않은 것으로 생각된다.

Keywords

References

  1. Lancet v.1 Profound hypothermia Drew CE;Keen G;Benazon DB
  2. Lancet v.1 Profound hypothermia in cardiac surgery Drew CE;Anderson IM
  3. Am J Cardiol v.58 Detection of cerebral injury after total circulatory arrest and profound hypothermia by estimation of specific creatinie kinase isoenzyme levels using monoclonal antibody technique Rossi R;Ekroth R;Lincoln(et al.)
  4. J Thorac Cardiovasc Surg v.30 Open left heart surgery in dogs during hypothermic asystole with and without extracoporeal circulation Gollan F;Phillips RJ;Grace JT;Jones RM
  5. Circulation v.49;50 no.suppl.Ⅱ Central nervous system consequences in infants of cardiac surgery using deep hypothermia and circulatory arrest Brunberg JA;Reilly EL;Doty DB
  6. Surgery v.86 Cerebral anoxia: Effect of deep hypothermia and pH Norwood W;Norwood C;Castaneda A
  7. J Thorac Cardiovasc Surg v.84 Profound hypothermia with circulatory arrest; Nine year's clinical experience Tharion J;Thonson DC;Celemajer JM(et al.)
  8. J Thorac Cardiovasc Surg v.86 The effect of hypothermic circulatory arrest time on cerebral function, morphology, and biochemistry Treasure T;Naftel DC;Cogner KA(et al.)
  9. J Thorac Cardiovasc Surg v.87 Relationship of brain blood flow and oxygen consumption to perfusion flow rate during profound hypothermic cardiopulmonary bypass Fox LS;Blackstone EH;Kirklin JW(et al.)
  10. Ann Thorac Surg v.41 The protective effect of profound hypothermia on the canine central nervous system during one hour of circulatory arrest O'Connor JV;Wilding T;Farmer P(et al.)
  11. J Thorac Cardiovasc Surg v.97 The effect of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral blood flow in infants and children Greeley W;Ungerleider R;Smith R(et al.)
  12. J Thorac Cardiovasc Surg v.97 Brain tissue pH, oxygen tension, and carbon dioxide tension in profoundly hypothermic cardiopulmonary bypass Ⅰ Watanabe T;Orita H;Kobayashi M(et al.)