心肌肌钙蛋白I对心内直视手术心肌损伤判定价值.docVIP

心肌肌钙蛋白I对心内直视手术心肌损伤判定价值 　 作者：郭训，刘琴湘，岑欢，邵兵，胡宁东，周海波 【摘要】 目的 探讨心肌肌钙蛋白I(cTnI)对心内直视手术心肌损伤的判定价值。方法 40例心脏瓣膜置换手术患者随机分为两组，冷晶体停跳液组(A组)，温血停跳液组(B组) 每组20例，分别于围术期多时点采取中心静脉血，测定血清cTnI、CK及CK-MB的水平。结果 术前两组的cTnl、CK及CK-MB水平均在正常范围，开放主动脉后l h至术后24 h达峰值，其后缓慢下降。术后24 h、48 h温血停跳液组cTnI水平明显低于冷晶体停跳液组(Plt;0.05)，CK-MB在开放主动脉后1 h温血停跳液组低于冷晶体停跳液组。cTnl峰值浓度与主动脉阻断时间呈直线正相关。结论 cTnl判定心内直视手术围术期心肌损伤的敏感性及特异性明显优于CK、CK-MB，对围术期心肌缺血损伤的诊断、预后及心肌保护效果的评价具有重要的临床价值。 【关键词】 心肺转流；心肌损伤；心肌肌钙蛋白I 　　Application of Cardiac Troponin I to the Diagnosis of Myocardial Injury During Open Heart Surgery Under Cardiopulmonary Bypass 　　Abstract: OBJECTIVE To evaluate the clinical value of cardiac troponin I(cTnI)in the diagnosis of myocardial ischemic injury during open heart surgery.METHODS Fourty patients under-going cardiac valve replacement operation were randomly divided into two groups：group A(cold crystalloid cardioplegia,n=20)and group B(warm blood cardioplegia,n=20). The central venous blood samples were taken at various times during perioperation to measure the serum levels of cTnI,CK-MB and CK.RESULTS cTnI,CK and CK-MB levels were normal before operation,increased markedly following aortic declamping,reached the peak value at 1 h after aortic declamping to 24 h after operation,and therefter decreased progressively to be normal in two groups.The serum cTnl level was significantly lower in group B than that in group A 24 h and 48 h after operation.The serum CK-MB activity was lower in group B than that in group A 1 h after aortic declamping.There was positive significant correlation between aortic clamping time and cTnI peak leve1．CONCLUSION cTnl can be used to evaluate the degree of myocardial injury and myocardial protective effect in open heart surgery，the sensitivity and specificity of cTnl are more valuable than those of myocardial enzymes. 　　Key words：Cardiopulmonary bypass；Myocardium injury；Cardiac troponin I 　　心肺转流（Cardiopulmonary bypass，CPB）作为非生理过程和心脏手术操作都可导致心肌损伤，因此围术期心肌损伤的监测非常重要。以往常将肌酸激酶(CK)及其同工酶(CK-MB)作为术中心肌损伤的监测指标，但两