非体外循环冠脉搭桥围术期心肌肌钙蛋白T的变化  

Monitoring cardiac troponin T as a marker of perioperative myocardial injury in patients undergoing off-pump coronary artery bypass grafting

作　　者：张冬梅[1] 魏宁[1] 王妙基 刘红[1] 

机构地区：[1]宁夏医学院附属医院,宁夏银川750004 [2]新加坡中央医院,169608

出　　处：《宁夏医学杂志》2004年第12期747-749,共3页Ningxia Medical Journal

摘　　要：目的　探讨肌钙蛋白T在非体外循环冠脉搭桥术 (OPCAB)中作为心肌损伤标志物的临床价值。方法　择期OPCAB患者 2 3例 ,ASAⅡ -Ⅳ级。于麻醉诱导前 (T1)、术毕返ICU即刻 (T2 )、返ICU后 6小时 (T3 )、2 4小时 (T4)抽取中心静脉血 5ml,测定肌酸激酶 (CK)、肌酸激酶同工酶蛋白质量 (CK -MBmass)、肌钙蛋白 (cTnT ) ;术前一天及术毕返ICU后 1小时 ,术后第 1天晨作标准 12导联ECG ,以评价早期临床效果。结果　麻醉诱导前所测各种心肌标志物多在正常范围内 ,术后均显著升高。CK、CK -Mbmass及cTnT在返ICU后 2 4小时达峰值 ,CK及cTnT升高程度无显著性差别 ,cTnT高于正常上限的比例明显高于CK -MBmass。 2例ECG提示围术期缺血性改变 ,cTnT升高显著。结论　cTnT与CK -MBmass在非体外循环冠脉搭桥术后变化规律相似 ,但cTnT更具敏感性和特异性。Objective To evaluate the clinical significance of cardiac troponinT in patients undergoing off-pump coronary artery bypass grafting (OPCAB).Methods Twenty-three patients with intractable unstable angina, ASA Ⅱ-Ⅳ, scheduled for OPCAB. Serum CK, CK-MBmass and cTnT concentrations were measured before induction of anesthesia, immediately after ICU, and 6h, 24h after ICU. 12-leade ECG were monited and compared before, 1h and first day after ICU.Results The value of CK, CK-MBmass and cTnT were all in normal range before induction of anesthesia, increased significantly immediately after and 6h, 24h after ICU. CK、CK-MBmass and cTnT reached the highest levels 24h after ICU. The degree of elevation was not different between CK and cTnT, but cTnT was significantly higher than that of CK-MBmass. There were two cases that were postoperative ECG with myocardial ischemic injury and cTnT increased significantly after postoperation.Conclusion CK-MBmass and cTnT are similar after postoperation of OPCAB, but cTnT is of higher sensitivity and specificity than CK-MBmass to evaluate the degree of perioperative myocareial injury.

关 键 词：冠状动脉分流术 肌钙蛋白 心肌 

分 类 号：R654.2[医药卫生—外科学]