心肌特异性脂肪酸结合蛋白在不停跳冠状动脉搭桥术围术期变化的研究  

Perioperative changes of serum heart-type fatty add binding protein in patients undergoing off-pump coronary artery bypass grafting

作　　者：陈新春[1] 朱敏敏[1] 袁冬喜[1] 钱燕宁[1] 刘训良[1] 傅诚章[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《国际麻醉学与复苏杂志》2007年第5期385-388,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的为了评价心肌特异性脂肪酸结合蛋白(hFABP)在不停跳冠状动脉搭桥术(OPCABG)嗣术期诊断心肌缺血损伤的效率,将其与肌钙蛋白Ⅰ(cTnI)、sCD40L和肌酸磷酸激酶同功酶(CK-MB)比较。方法随机择期OPCABG病人38例,在术前、术中吻合血管时、手术结束时、术后6 h、18 h和36 h采集血样,测定血清中hFABP、cTnI、sCD40L和CK-MB水平。结果有6例(16.7%)在手术中出现ECG的ST段上升>0.1 mV或肺毛细血管楔压(PCWP)>18 mm Hg的心肌缺血损伤,其血清hFABP、cTnI、sCD40L、CK-MB系列浓度均保持在较高的水平,血清hFABP浓度的峰值比cTnI、sCD40L、CK-MB浓度峰值均高并提前数小时出现;而32例病人(83.3%)血清hFABP、cTnI、sCD40L、CK-MB系列浓度均保持在较低的水平。结论与sCD40L、cTnI和CK-MB相比,hFABP对OPCABG围术期心肌缺血损伤具有更快速、更易于诊断的价值。Objective To appraise the sensitivity of heart -type fatty acid binding protein （hFABP） for detection of myocardial ischernia in patients undergoing off - pump coronary artery bypass grafting （OPCABG） among cardiac markers. Methods 38 consecutive patients undergoing OPCABG were included in the study using standardized operative procedures and myocardial protection. Blood samples were taken preoperatively, during anastomoses, in the end of operation, at postoperative 6 h, 18 h and 36 h, respectively, and the serial serum levels of hFABP, cTnI, sCD40L, and CK - MB were assayed. Results Myocardial injury was detected with ECG or PCWP in six cases （ 16.7% ） during OPCABG, and the serial serum levels of hFABP, cTnl, sCD40L, and CK - MB were all higher in these patients than those without myocardial injury. Peak level of scrim hFABP appeared earlier and with higher amplitude than those of serum cTnI, sCD40L, and CK - MB. Conclusion The above results suggest that serum hFABP is a faster responding and more sensitive biochemical marker for the diagnosis of myocardial injury in patients undergoing OPCABG.

关 键 词：心脏特异性脂肪酸结合蛋白 心肌缺血 冠状动脉旁路移植 靶浓度控制输注 

分 类 号：R654.2[医药卫生—外科学]