60岁及以上患者非心脏手术后心肌损伤标志物的改变  

Changes of myocardiac injury markers after noncardiac surgery in patients aged more than 60 years

作　　者：沈亮[1] 胡湘[1] 杨笑萱 陆志俊[2] 罗艳[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院卢湾分院麻醉科,上海200020 [2]上海交通大学医学院附属瑞金医院麻醉科

出　　处：《上海医学》2017年第3期148-151,共4页Shanghai Medical Journal

基　　金：上海市卫生和计划生育委员会课题资助项目(201540315)

摘　　要：目的观察年龄≥60岁患者非心脏手术后心肌损伤标志物的改变。方法选择年龄≥60岁行择期胃、肠道外科手术的患者120例,平均年龄为(65.12±6.72)岁,男、女各60例,美国麻醉医师协会(ASA)分级Ⅱ或Ⅲ级。在进人手术室(T_0)、麻醉诱导后(T_1)、气管插管后(T_2)、切皮后(T_3)、探查腹腔后(T_4)、手术结束即刻(T_5)、拔除气管导管后(T_6)各时间点,记录患者的平均动脉压(MAP)和心率。分别在手术开始前、手术结束后、术后第1天、术后第2天晨抽取患者静脉血2 mL,检测心肌肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)和N末端脑钠肽前体(NT-proBNP)水平。结果与T_0时间点比较,T_1时间点的心率显著减慢、MAP显著降低(P值均<0.05),而T_2时间点的心率显著加快、MAP显著升高(P值均<0.05),T_3至T_6时间点的心率和MAP与T_0时间点的差异均无统计学意义(P值均>0.05)。与手术开始前比较,术后第1天的心肌Myo和NT-proBNP水平均显著升高(P值均<0.05);手术结束后和术后第2天的心肌Myo和NT-proBNP,水平,以及术后各时间的CK-MB与手术开始前的差异均无统计学意义(P值均>0.05)。结论年龄≥60岁患者非心脏手术后会引起血浆心肌损伤标志物Myo、NT-proBNP水平升高。Objective To observe the changes of myocardial injury markers after noncardiac surgery in patients aged more than 60 years. Methods One hundred and twenty elderly patients （≥60 years old） who underwent elective gastric and intestinal surgery were selected in this study. There were 60 males and 60 females with the average age of （65.12±6.72） years old and their American Society of Anesthesiologists （ASA） physical status was grade Ⅱ or Ⅲ. Mean arterial pressure （MAP） and heart rate were recorded at the following time points： after entering the operation room （To）, after induction of anesthesia （T1）, after tracheal intubation （T2）, when cutting the skin （T3）, after abdominal exploration （T4）, at the end of surgery （T5）, and after extubation （T6）. Venous blood 2 mL was collected preoperatively, and immediately, 1st day and 2nd day postoperatively. Plasma myohemoglobin （Myo）, creatine kinase- MB （CK-MB） and plasma N-terminal pro brain natriuretic peptide （NT-proBNP） were detected. Results Compared with those at To, MAP and heart rate decreased significantly at T1 （both P〈0.05）, while they increased significantly at T2 （both P〈0.05）. MAP and heart rate from T3 to T6 were similar to those at To （all P〉0.05）. Myo and NT-proBNP levels on the the first day morning after surgery were significantly higher than the preoperative ones （both P,〈0. 05）, while Myo and NT-proBNP levels at the end of surgery and on the second day after surgery were similar to the preoperative ones （all P〉0. 05）. There were no significant difference in CK-MB level at any time point （all P〉0.05）. Conclusion The plasma Myo and NT-proBNP concentrations will increase after noncardiac surgery in aged patients. （Shanghai Med J, 2017, 40： 148-151）

关 键 词：肌红蛋白 肌酸激酶同工酶 N末端脑钠肽前体 非心脏手术 

分 类 号：R614[医药卫生—麻醉学]