冠状动脉旁路移植术围术期心肌标志物的应用价值  

Evaluate of the cardiac markers in the use of perioperative myocardial injury in patients undergoing coronary artery bypass graft surgery

作　　者：张冬梅[1] 王妙基 黄念慈 施伟忠[1] 刘红[1] 

机构地区：[1]宁夏医学院附属医院麻醉科,银川市750004 [2]新加坡中央医院国家心脏中心麻醉科,169608

出　　处：《实用医学杂志》2004年第9期1024-1026,共3页The Journal of Practical Medicine

摘　　要：目的 :观察冠脉搭桥术患者围术期心肌标志物测定值的变化 ,评价其对判定心肌损伤的应用价值。方法 :3 1例择期冠状动脉旁路移置术 (CABG)患者 ,分别于麻醉诱导前 (T1) ,术毕返ICU即刻 (T2 ) ,返ICU后 6h(T3 ) ,2 4h(T4)抽取静脉血样 5mL ,用于血清谷草转氨酶 (AST)、乳酸脱氢酶 (LDH )、肌酸激酶 (CK )、磷酸肌酸激酶同工酶 (CK MBmass)、心肌肌钙蛋白T(cTnT)和肌红蛋白 (Myo)的测定。结果 :麻醉诱导前所测各种心肌标志物中位数皆在正常范围内 ,术毕返ICU即刻至 2 4h均明显升高 ,AST、CK MBmass及cTnT术后 6h达峰值 ,Myo则在术后返ICU即刻达峰值 ,LDH、CK以术后 2 4h最为明显 ,CK、CK MBmass及cTnT升高程度差异无显著性 ,但均明显高于AST、LDH。CK MBmass与cTnT峰值呈正相关 (r =0 5 7,P <0 0 1)。结论 :cTnT具有心肌特异性 ,CK MBmass与cTnT在CABG术后变化规律相似 ,两者都可作为监测围术期心肌损伤较可靠的指标 ,但cTnT较CK MBmass高于正常且持续时间长。Objective To evaluate the cardiac ma rk ers in the use of perioperative myocardial cell damage in patients undergoing co ronary artery bypass graft surgery (CABG). Methods 31 patients scheduled for CABG, Serum AST, L D H, CK, creatine kinase-MB isoenzyme(CK-MBmass), cardiac troponin T(cTnT) and m yo globin(Myo) were measured before induction of anesthesia, immediately after ICU, 6 h and 24 h after ICU. Results The median value of cardiac markers levels were all i n normal range before induction of anesthesia, and increased significantly immed iately after ～24 h after ICU. AST, CK-MBmass and cTnT levels reached peak valu e at 6 hour after ICU. Myoglobin peak value was immediately after ICU. LDH and CK levels reached the highest value 24 h after ICU. The degree of elevation was not different among CK, CK-MBmass and cTnT, which were significantly higher than th at of AST and LDH. CK-MBmass was related to the cTnT (r=0.57,P<0.01). Conclusion cTnT is provided with the specificity of cardiac t roponins. CK-MBmass and cTnT are similar in the regular of release after CABG, b oth are as reliable perioperative monitoring indicators in patients undergoing C ABG, but cTnT is of larger diagnostic time window than CK-MBmass.

关 键 词：CK-MBMASS 心肌标志物 ICU 围术期 术后 AST CABG 结论 乳酸脱氢酶(LDH) 中位数 

分 类 号：R654.2[医药卫生—外科学]