围体外循环期肌钙蛋白I的临床研究——判断心肌保护的一个新指标  

Clinical studies on the changes of cTn-I during cardiopulmonary bypass with or without beating heart:a new indicator for estimation of the myocardial protective effects

作　　者：高秉仁[1] 刘亚涛[1] 岳凤珍[1] 赵宏林[1] 刘胜利[1] 谢建民[1] 梁小玲[1] 

机构地区：[1]兰州医学院第一附属医院心脏外科,甘肃兰州730000

出　　处：《西北国防医学杂志》2004年第4期248-250,共3页Medical Journal of National Defending Forces in Northwest China

基　　金：全军"十五"医药卫生重点科研基金资助项目 ( 0 1-L0 0 3 )

摘　　要：目的 :探讨先天性心脏病 (先心病 )矫治术中心脏不停跳与心脏停跳两种术式对肌钙蛋白I(cTn -I)的影响 ,阐明cTn -I是判断不同术式心肌保护效果的一个新指标。方法 :36例先心病矫治术患者随机分为两组 ,冷晶体停跳组 (组Ⅰ ) ,心脏不停跳组 (组Ⅱ )。分别于各时段抽血 ,测定cTn -I、肌酸激酶 (CK)、肌酸激酶同工酶 (CK -MB)、乳酸脱氢酶 (LDH)。同时行电镜观察手术前后心肌超微结构变化。结果 :术后各时点组ⅠcTn -I明显高于组Ⅱ (P <0 .0 5 ) ;组ⅠCK -MB、CK、LDH明显高于组Ⅱ (P <0 .0 5 )。电镜观察组Ⅱ术后心肌超微结构无明显变化 ,而组Ⅰ受损程度分级与术前比较差异有显著性。结论 :先心病矫治术中心脏不停跳明显减轻了心肌缺血缺氧及再灌注损伤 ,减少了cTn -I的释放 ,较冷晶体停跳术有良好的心肌保护效果。肌钙蛋白I是判断心肌保护效果的一个灵敏的新指标。Objective:To investigate the content changes of cardiac troponin I (cTn-I) during correction operation of congenital cardiac defects with or without beating heart,and evaluate cTn-I as a new indicator for estimation of the myocardial protective effects. Methods:36 patients undergoing correction operations of cardiac defects were randomly divided into two groups:group I (cold crystolloid cardioplegia. n =18) and group II (beating heart,n =18). The central venous blood samples were taken at various time perioperatively to measure the serum level of cTn-I,CK,CK-MB and LDH. Myocardial tissues were obtained from the first 8 patients in each group when inserting superior vena cava cannula and after 15 min of aorta unclamping (group I) or suturing right artrial wall (group II). The ultrastructure of the myocardial samples was observed by electron microscope. Results:The levels of cTn-I and CK-MB in group I was significantly higher than that in group II at all stages after operation ( P <0.05). cTn-I reached peak at earlier time than CK-MB. However,the grade of injury degree after operation was significantly higher than that before operation at group I. Conclusion:the release of cTn-I is decreased apparently during correction operation of cardiac defects with beating heart,which help to reduce ischemia-reperfusion injury. CTn-I is a new indicator for estimation of the myocardial protective effects.

关 键 词：心脏不停跳 缺血再灌注损伤 肌钙蛋白-I 心肌超微结构 

分 类 号：R654.2[医药卫生—外科学]