冠状动脉旁路移植术围术期cTnI的变化  

Change of perioperative release of cardiac troponin I in patients undergoing coronary artery bypass grafting

作　　者：方继瀛[1] 柳克晔[2] 周程[2] 韩喆[2] 周晓东[2] 

机构地区：[1]河北大学,河北保定071000 [2]河北大学附属医院心脏科,河北保定07100

出　　处：《医学研究与教育》2011年第1期23-27,共5页Medical Research and Education

基　　金：河北省卫生厅跟踪项目(GL200801)

摘　　要：目的观察非体外循环冠状动脉旁路移植术(OpCABG)与常规体外循环冠状动脉旁路移植术(CCABG)围术期肌钙蛋白I(cTnI)的变化规律,评估两种手术方式心肌损伤的差异。方法连续性选取100例行冠状动脉旁路移植术患者,男女不限,分为CCABG组和OpCABG组,每组各50例,CCABG组于肝素化前,主动脉开放后即刻、3、6、12、24h;OpCABG组于肝素化前,第一支移植动脉开始灌注后即刻、3、6、12、24h抽取静脉血,检测血清cTnI、CK-MB值。结果 2组肝素化前cTnI、CK-MB均处于正常范围,cTnI术后各时间点均明显升高,24h达峰值,CCABG组升高时间早于OpCABG组,且峰值明显高于OpCABG组,CK-MB变化趋势与cTnI相似,6h达峰值,2组参数间有统计学意义(P<0.05),CCABG组中有8例ST-T改变,OpCABG组中有10例ST-T改变。2组中ST-T改变患者cTnI峰值明显高于ST-T无改变者,CK-MB升高幅度明显小于cTnI。结论 OpCABG与CCABG围术期cTnI、CK-MB变化规律相似,与CCABG相比,OpCABG能明显降低心肌损伤,cTnI与心肌损伤程度密切相关,其敏感性高于CK-MB。Objective To investigate the changes of perioperative release of cardiac troponin I（cTnI）in patients undergoing off-pump coronary artery bypass grafting（OPCABG）and conventional coronary artery bypass grafting（CCABG） and evaluate the difference of myocardial injury between OPCABG and CCABG.Methods 100 consecutive patients were randomly assigned to CCABG group and OPCABG group.The cTnI and CK-MB concentrations were measured in serial blood samples drawn before heparinization in both groups and after aortic unclamping at 0,3,6,12and 24 hours in the CCABG group.In the OPCABG group,samples were taken after the first distal anastomosis perfusion at the same time intervals as CCABG.Group.Results All variables before heparinization were within normal range and the concentrations of cTnI and CK-MB after heparinization were significantly higher.Reached peak at 24h after declamping for cTnI and reached peak at 6h after declamping for CK-MB,cTnI in the CCABG group increased significantly earlier and the peak higher than in OPCABG group.The parameters were statistically significant different between the two groups.Conclusion The increasing trend of cTnI and CK-MB were similar between OPCABG and CCABG,the myocardial injury of OPCABG were decreased significantly than CCABG,cTnI was directly bound up with myocardial injury and had higher sensitivity in detecting myocardial damage than CK-MB.

关 键 词：肌钙蛋白I 冠状动脉旁路移植术 围术期 

分 类 号：R654[医药卫生—外科学]