心肌肌钙蛋白T在换瓣手术围术期动态变化及其意义_医学论文.docVIP

心肌肌钙蛋白T在换瓣手术围术期动态变化及其意义_医学论文 心肌肌钙蛋白T在换瓣手术围术期动态变化及其意义_医学论文 【摘要】 目的 探讨心肌肌钙蛋白T（cTnT）在换瓣手术围术期的动态变化及其临床意义。方法 选取20例行换瓣手术的患者，其中男14例，女6例，平均年龄（28.4±18.12）岁，平均体重（52.2±27.13）kg，分别于转流前、主动脉阻断时、主动脉开放时、转流停止时、手术结束时、术后1h、1天、3天和7天采取血清测定cTnT和CK-MB，并选取10例非心脏病胸科手术病人于术前及术后24h检测血清cTnT和CK-MB。结果 cTnT和CK-MB均与主动脉阻断时间呈正相关，r分别为0.814和0.662，cTnT和CK-MB呈正相关，r=0.833。cTnT术后比CK-MB更早达到峰值，且持续时间更长。非心脏病胸科手术患者测值中，cTnT均正常，而有4例术后CK-MB升高。结论 cTnT的敏感性和特异性均优于CK-MB，可望作为心脏外科心肌保护的常规检测指标。 【关键词】 心肌保护；心肌肌钙蛋白；敏感性；特异性 【Abstract】 Objective To estimate the clinical value of Troponin T as a marker in assessing myocardial cell damage in patients undergoing valve replacement operation.Methods Troponin T together with CK-MB were measured in serial blood samples from 20 patients undergoing valve replacement operation (preoperatively， aorta clamping， aorta off clamping， at the end of CPB and the operation， and subsequently at one hour， one day， three days and one week after the end of operation).The above two indications were also examined before and after operation in 10 patients undergoing thoracic surgery.Results Peak concentrations were reached earlier in cTnT than in CK-MB， and the circulation cTnT remained high when CK-MB had already decreased to normal.In 10 patients undergoing thoracic surgery， Troponin T was normal while CK-MB was found higher than normal in 4 patients after surgery.Conclusion Troponin T was more sensitive and specific than CK-MB when determine myocardial cell damage in patients undergoing cardiac surgery.Troponin T can be used as a routine indication for myocardium preservation. 【Key words】 myocardium preservation；Troponin T；sensitivity；specificity 多年来检测CPB围术期心肌细胞损伤的各种方法在灵敏性、特异性及实用性等方面尚未有完全令人满意者。心肌肌钙蛋白T（cTnT）为近来研究较多的一种心肌收缩调节蛋白［1］，本研究的目的即是探讨其在体外循环围术期的变化规律及其临床意义。 1 资料与方法 1.1 一般资料 20例心内直视手术病人中男14例，女6例。年龄25～57岁，平均(28.4±18.12)岁。体重47～72kg，平均(52.2±27.13)kg。手术类型：二尖瓣置换术13例，主动脉瓣置换术3例。二尖瓣+主动脉瓣置换术3例，二尖瓣置换+三尖瓣环成形术1例。手术在全麻、低温CPB下进行。全组病人术前肝、肾功能及电解质正常。无高血压及冠心病史。10例非心脏病胸外手术病人，男7例，女3例，年龄22～60岁，平均年龄(30.2±