心脏直视术后心肌肌钙蛋白Ⅰ的转归及其影响因素相关性分析  

Analysis on the release of serum troponin I and its relation to perioperative mulfactors following open heart surgery in children

作　　者：蔡及明[1] 周燕萍[1] 史珍英[1] 陈玲[1] 徐志伟[1] 苏肇伉[1] 杨艳敏[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心心胸外科,上海200127

出　　处：《临床儿科杂志》2004年第11期744-747,共4页Journal of Clinical Pediatrics

摘　　要：目的探讨心脏直视术后心肌肌钙蛋白Ⅰ(TnTi)的转归,并就其与各影响因素作相关性分析。方法收集57例中低温体外循环下行心内畸形纠治术后患儿,年龄(2.34±2.11)岁.体重(10.92±4.59)kg。按病种不同分为A组(法洛氏四联症组,n=31)和B组(室间隔缺损组,n=26)。分别测定术前、主动脉开放5min、6h、12h、24h、48h、72h7个时相点血清TnTi浓度和心功能评分(score),记录体外转流时间(TT)、主动脉阻断时间(CT)以及监护窒预后情况。结果①与术前相比,主动脉开放5min时TnTi显著升高达到峰值(P<0.01),72h后仍高于术前水平(P<0.01);A组患儿血清TnTi显著高于B组患儿,两组cTnTi峰值分别是术前的118和55倍。②患儿TT、CT、手术机械损伤部位及程度与TnTi浓度呈正相关,相关系数分别为0.51、0.51、0.35(P均<0.01)。score与TnTi浓度呈负相关,相关系数为-0.52(P<0.01)。③2.3μg／L是预估患儿术后心功能恢复以及指导临床治疗的临界值。结论TnTi是心脏直视术后评价心肌受损的可靠指标,对反映患儿术后心功能的恢复有一定参考价值。Objective To measure serum TnTi levels after open heart surgery in children and evaluate the correla-tionship between TnTi and perioperative multi-factors. Methods 57 children(age 2.34±2.11 years,weight 10.92±4.59 kg) undergoings elective correction of congenital heart diseases under moderate systemic hypothermia were divided into group A (TOF,n=31 )and group B(VSD,n =26).Blood samples were drawn preoperatively,5 minutes (T0) ,6hs(T6), 12hs(T12) ,24hs (T24),48hs(T48),72hs(T72)after removal of aortic cross clamp. Demographic information,cardiac defect,repair performed, duration of bypass (CPBT), cross-clamp time (CCT) ,clinical scores for cardiac function and outcomes were recorded. Results (1)Compared with baseline value,serum levels of troponin I peaked at T0(P<0.01) ,and was still higher than baseline value at T72 (P<0.01 ).Peak levels of TnTi were 118 and 55 times higher than baseline value respectively in group A and in group B.(2)There was a positive correlationship between peak levels of TnTi and TT (r=0.51 ,P<0.01,CT (r=0.51, P<0.01 ),myocardial operative injury including ventriculotomy and muscle resection (r=0.35 ,P<0.01).Whereas,peak levels of TnTi was negatively correlated to clinical score for cardiac function (r=-0.52;P<0.01 ).(3)2.3ug/L was a critical level which could highly predict the postoperative recovery and inotropic support. Conclusions Postoperative serum troponin I level is a highly specific and sensitive marker for myocardial ischemia and injury; therefore, its measurement may contribute to the assessment of recovery and outcome after open heart surgery.

关 键 词：心肌肌钙蛋白 小儿心脏直视术 心肌损害 心功能 

分 类 号：R726.5[医药卫生—儿科]