心肌肌钙蛋白Ⅰ在评价心脏直视手术心肌缺血再灌注损伤的应用  

Use of Cardiac Troponin I to Diagnose Myocardial Ischemic Reperfusing Injury in Open Heart Surgery

作　　者：程述森[1] 王兰兰[1] 张尔永[1] 李立新[1] 郭应强[1] 杨建[1] 安琪[1] 

机构地区：[1]华西医科大学附属第一医院胸心外科

出　　处：《中国胸心血管外科临床杂志》1999年第2期89-92,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探索心脏直视手术中心肌缺血再灌注损伤的快速准确的诊断方法。方法３５例患者按病种分为３组，组１：１０例风湿性心脏瓣膜病患者；组２：１５例先天性心脏病患者；对照组：１０例食管癌或肺癌患者。使用Ｂｅｃｋｍａｍ－ＣｏａｌｔｅｒＡｃｃｅｓｓ微粒子化学发光分析仪及配套试剂于转流前（组３为术前）、术毕、术后８～１２小时、２４小时、７２小时和７天对心肌肌钙蛋白Ⅰ（ｃａｒｄｉａｃｔｒｏｐｏｎｉｎⅠ，ｃＴｎＩ）、磷酸肌酸激酶同工酶（ｃｒｅａｔｉｎｅｋｉｎａｓｅＭＢｍａｓｓ，ＣＫ－ＭＢｍａｓｓ）以及肌红蛋白（ｍｙｏｇｌｏｂｉｎ）３种指标进行检测，其结果结合临床资料和心电图分析比较。结果组１和组２患者都存在不同程度的心肌缺血再灌注损伤，３种检验的敏感性相同；ｃＴｎＩ较ＣＫ－ＭＢｍａｓｓ和肌红蛋白更特异反映心肌损伤；组１主动脉阻断时间长、ｃＴｎＩ浓度升高明显、持续时间也越长，反映了心肌缺血损害较重，与组２比较差异有显著性（Ｐ＜０．０５）。结论ｃＴｎＩ在心脏直视手术心肌缺血再灌注损伤的诊断中具有高度的敏感性和特异性，ｃＴｎＩ浓度反映了心肌损害的程度，并对预后有直接影响。ＣＫ－ＭＢｍａｓｓ和肌红蛋白敏感性与ｃＴｎＩ相同。Objective To detect the diagnosis value of the new markers for myocardial ischemia reperfusing injury in open heart surgery. Methods Thirty five patients classified into 3 groups, group 1: Ten cases undergoing heart valve replacement; group 2:Fifteen cases undergoing corrected operation for congenital heart disease; control group:As control study include 10 operative cases of lung or esophageal carcinoma. Cardiac troponin I(cTn I), creatine kinase MBmass(CK MBmass), myoglobin concentrations were measured by immunoenzymometric assay (Beckmam Coalter Access),serial venous blood samples were obtained from 35 patients before cardiopulmonary bypass, after operation, postoperative 8 12hrs,24hrs,72hrs and daily lasting 7 days. Results The sensitivity of cTn I is similar to that of CK MBmass or myoglobin for diagnosis of myocardial damage during surgery. The longer aortic cross clamping time, the higher concentration of cTn I. Serum concentration of cTn I are significantly higher in group 1 than in group 2 at 8 12 hrs and 24 hrs( P <0 05). Conclusion The measurement of cTn I is a sensitive and specific method for the diagnosis of myocardial ischemia reperfusion injury in open heart surgery. It avoids the high incidence of false diagnosis associated with the use of CK MBmass or myoglobin as a diagnosis marker.

关 键 词：心脏外科手术 心肌缺血 再灌注损伤 

分 类 号：R654.205[医药卫生—外科学]