非体外循环冠状动脉旁路移植术后早期心肌肌钙蛋白I检测的临床价值  

Clinical Value of Cardiac Troponin I in the Early Postoperative Period of Off-pump Coronary Artery Bypass Grafting

作　　者：杨威[1] 陈彧[1] 凌云鹏[1] 陈生龙[1] 刘刚[1] 董穗欣[1] 李辉[1] 鲍黎明[1] 

机构地区：[1]北京大学人民医院心脏中心心脏外科,北京100044

出　　处：《中国胸心血管外科临床杂志》2013年第6期658-663,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨心肌肌钙蛋白Ⅰ （cTnI）在非体外循环冠状动脉旁路移植术（OPCAB）后升高的临床意义及其对患者早期预后的预测价值。 方法 选取2011年于北京大学人民医院心脏外科行单纯OPCAB手术的患者240例，其中男164例、女76例，年龄36～83 （62.07±8.24） 岁。监测术后4～6 h、12～18 h血清cTnI水平，分析其相关影响因素及对术后早期预后的预测价值。采用二元logistic回归分析、相关性分析及受试者工作特征（ROC）曲线进行统计学分析。 结果 术后4～6 h血清cTnI值（TNI0）为（1.28±0.40） ng/ml，术后12～18 h血清cTnI值（TNI1）为（3.60±0.74） ng/ml。以中值为切点使用二元logistic回归分析，提示桥血管数目是TNI0 （P=0.000）及TNI1 （P=0.010）的显著影响因素，术后12～18 h的cTnI值与预后显著相关（P＜0.05），但相关关系并不密切（相关系数＜0.5）。ROC曲线分析提示术后12～18 h的cTnI值对患者预后的预测价值更大（P＜0.05），术后12～18 h的cTnI＞1.49 ng/ml对术后心电图（ECG）改变、主动脉内球囊反搏（IABP）使用及住院死亡具有较好的预测价值。 结论 OPCAB术后早期cTnI水平有不同程度的升高，结合心电图改变可用于早期诊断围术期心肌梗死，对早期预后具有较大预测价值。Objective To identify clinical significance of high level cardiac troponin I （cTnI） in the early postoperative period of off-pump coronary artery bypass grafting （OPCAB） and its predictive value for early clinical outcomes. Methods A total of 240 patients undergoing isolated OPCAB in the Department of Cardiac Surgery of People’s Hospitalof Peking University during 2011 were recruited in the study. There were 164 males and 76 females with their age of 36-83（62.07±8.24） years. Serum cTnI levels in 4-6 hours and 12-18 hours after OPCAB were monitored. Influential factors and its predictive value for early clinical outcomes of OPCAB were analyzed. Binary logistic regression analysis，correlation analysis and receiver operating characteristic （ROC） curve were performed for statistic analysis. Results Serum cTnI level in 4-6 hours after OPCAB （TNI0） was 1.28±0.40 ng/ml，and serum cTnI level in 12-18 hours after OPCAB （TNI1） was 3.60±0.74 ng/ml. Binary logistic regression analysis revealed that graft number was significant influential factors of TNI0 （P=0.000） and TNI1 （P=0.010）. Serum cTnI level in 12-18 hours after OPCAB was significantly correlated with early clinicaloutcomes of OPCAB （P＜0.05），but the correlational relationship was not strong （correlation coefficient＜0.5）. ROC curveanalysis showed that serum cTnI level in 12-18 h after OPCAB had higher predictive value for patient prognosis （P＜0.05）. Serum cTnI level higher than 1.49 ng/ml in 12-18 h after OPCAB had good predictive value for postoperative ECG changes，use of intra-aortic balloon pump （IABP） and in-hospital mortality. Conclusions Serum cTnI level increases in varying degrees in the early postoperative period of OPCAB. Together with ECG changes，serum cTnI level can be used for early diagnosis of perioperative myocardial infarction with significant predictive value for early clinical outcomes of OPCAB.

关 键 词：冠状动脉旁路移植术 非体外循环 心肌肌钙蛋白Ⅰ 心肌梗死 

分 类 号：R654.2[医药卫生—外科学]