缺血修饰白蛋白在体外循环心内直视术后的变化及临床应用价值  

Research on the values of ischemia modified albumin underwent cardiopulmonary bypass intracardiac operation under direct vision

作　　者：徐斐[1] 徐晓杰[2] XU Fei;XU Xiao-jie(Clinical Laboratory,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China;不详)

机构地区：[1]温州医科大学附属第一医院检验科,浙江温州325000 [2]温州医科大学附属第二医院检验科,浙江温州325000

出　　处：《中国卫生检验杂志》2020年第7期830-832,共3页Chinese Journal of Health Laboratory Technology

摘　　要：目的探讨体外循环(cardiopulmonary bypass,CPB)心内直视术围术期缺血修饰白蛋白(ischemia modified albumin,IMA)的变化规律及其在术后心肌损伤早期检测中的临床应用价值。方法收集2017年5月-2018年12月温州医学院附属第二医院胸外科住院的先天性心脏病室间隔缺损患儿46例,均CPB下行室缺修补术。分别于术前(T1)、主动脉阻断开放即刻(T2)、开放后30 min(T3)、开放后1 h(T4)、术后6 h(T5)、术后24 h(T6)采集外周动脉血,测定IMA、心肌肌钙蛋白I(cTnI)的浓度,分析各指标在围手术期的变化规律。分别分析IMA与cTnI峰值浓度的相关性,以及IMA峰值浓度与主动脉阻断时间(aortic cross-clamp time,ACCT)、体外循环时间(cardiopulmonary bypass time,CPBT)的相关性。结果对照T1,在T2、T3、T4、T5时各指标测定结果均显著增高(P<0.01)。IMA与cTnI呈正相关(r=0.815,P=0.001)。IMA与ACCT、CPBT呈正相关(r值分别为0.735、0.652,P=0.001)。结论IMA在CPB心内直视手术后迅速升高,峰值出现早于cTnI,但持续时间较cTnI短,更有利于心肌损伤的早期检测及再发心肌缺血的诊断。IMA与cTnI的峰值浓度呈正相关,提示IMA能较好地反映心肌损伤程度,可用于体外循环心内直视手术心肌损伤的早期检测。Objective To research on the values of ischemia modified albumin underwent cardiopulmonary bypass intracardiac operation under direct vision.Methods From May 2017 to December 2018,46 children with congenital heart disease and ventricular septal defect admitted to the Department of Thoracic Surgery of the Second Affiliated Hospital of Wenzhou Medical College were collected.All patients underwent CPB descending ventricular defect repair.Peripheral arterial blood was collected before surgery(T1),immediately after aortic occlusion(T2),30 min(T3)after opening,1 h(T4)after opening,6 h(T5)after operation,and 24 h(T6)after operation.The concentrations of IMA and cardiac troponin I(cTnI)were measured,and the changes of each index during the perioperative period were analyzed.The correlation between IMA and cTnI peak concentrations was analyzed,and the correlation between peak IMA concentration and aortic cross-clamp time(ACCT),cardiac bypass time(CPBT).Results Compared with T1,the measurement results of each index were significantly increased at T2,T3,T4,and T5(P<0.01).IMA was positively correlated with cTnI(r=0.815,P=0.001).IMA was positively correlated with ACCT and CPBT(r=0.735,r=0.652,P=0.001).Conclusion IMA increased rapidly after CPB open heart surgery,and the peak value appeared earlier than cTnI,but the duration was shorter than cTnI,which is more conducive to the early detection of myocardial damage and the diagnosis of recurrent myocardial ischemia.There is a positive correlation between IMA and the peak concentration of cTnI,suggesting that IMA can better respond to the degree of myocardial injury and can be used for the early detection of myocardial injury during open heart surgery with extracorporeal circulation.

关 键 词：缺血修饰白蛋白 体外循环 心肌肌钙蛋白I 心肌损伤 

分 类 号：R654.2[医药卫生—外科学]