心肌肌钙蛋白I对体外循环心内直视手术心肌损伤的判定价值  

Application of Cardiac Troponin I to the Diagnosis of Myocardial Injury During Open Heart Surgery Under Cardiopulmonary Bypass

作　　者：郭训[1] 刘琴湘[1] 岑欢[1] 邵兵[1] 胡宁东[1] 周海波[1] 

机构地区：[1]暨南大学医学院第五附属医院,广东清远511500

出　　处：《实用医学进修杂志》2006年第3期158-162,共5页Journal of Practical Training of Medicine

摘　　要：目的：探讨心肌肌钙蛋白I（cTnI）对体外循环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病人随机分为两组,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眺组（P＜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.Objective： To evaluate the clinical value of cardiac troponin I （cTnI） in the diagnosis of myocardial ischemic injury during open heart surgery under eardiopulmonary bypass（CPB）. Methods： Fourty patients under - going cardiac valvular replacement operation were randomly divided into two groups： group A （cold erystalloid ardioplegia, 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 levds of cTnI, CK - MBand CK. Results： cTnI, CK and CK - MB levels were nomtal before operation, increased markablely following aorta unclamping, reached the peak 1h after aorta unclamping to 24 h after operation, and decreased progressively to be normal in two groups. The serum cTnI 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 aorta unclamping. There was positive significant correlation between aorta cross - clamping time and cTnI peak level. Conclusions： cTnI can be used to evaluate the degree of myocardial injury and myocardial protective effect in open heart surgery during CPB. As indicators for reflecting the myocardial injury, the sensitivity and specificity of cTnI are more valuable than those of myocardial enzymes.

关 键 词：体外循环 心肌损伤 心肌肌钙蛋白I 诊断 

分 类 号：R654.1[医药卫生—外科学]