常温不停跳心内直视手术期间心肌损伤早期标志物的变化及其临床意义  

EARLY CARDIAC INJURY MARKERS DURING BEATING HEART DIRECT VERSION INTRAC- ARDIAC SURGERY AND ITS CLINICAL SIGNIFICANCE

作　　者：韦方 邓云坤 张大国 李红 杨素萍 杨静 刘漫霞 

机构地区：[1]贵州省心血管病医院,贵州省贵阳市550002

出　　处：《中国心血管病研究》2004年第1期19-21,共3页Chinese Journal of Cardiovascular Research

基　　金：本课题为贵州省科学技术委员会资助项目;编号:黔基合3402

摘　　要：目的 探讨常温不停跳心内直视手术期间心肌损伤早期标志物的动态变化及其对预后的指导意义。方法选择48例择期二尖瓣置换术患者,分别于术前、术后即刻、术后12h、24h及48h等时点取静脉血检测C-反应蛋白(CRP)、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(Tn-T)、肌钙蛋白I(Tn-I)浓度变化,同时记录心电图(ECG)、血流动力学指标及不良事件发生情况,并作相关分析。结果 术前所有患者血浆CRP、CK-MB、Tn-T、Tn-I均在正常范围,术后即刻上述指标明显升高(P<0.05 or 0.01),其中38例于术后12h达高峰,术后48h降至正常水平,9例患者CRP、CK-MB、Tn-T、Tn-I于术后即刻开始持续升高(P<0.01),术后48h仍显著高于正常,其中2例死亡,7例发生术后低心排和/或严重心律失常;相关分析显示术后死亡及不良事件发生与血清Tn-T、Tn-I水平呈正相关(r分别为0.71和0.68,P<0.001)。结论 常温不停跳心内直视手术后心肌损伤早期标志物明显升高,并于术后12h达峰值,其持续升高与术后不良事件的发生密切相关。Objective To investigate the changes of early cardiac injury markers during beating heart direct version intracardiac surgery and their clinical significance. Methods 48 patients undergoing elective direct version intracardiac surgery (mitral valve replacement, MVR) were chosen. Changes of C- reactive protein(CRP), creatine kinase isoenzyme(CK - MB), cardiac troponin T(cTnT) and cardiac troponin I(cTnI) were detected at different time points. Electrocardiogram(ECG), hemodynamic parameters and clinical outcomes were recorded simultaneously. Results The early cardiac injury markers were significantly elevated at the very time after the operation, reached the highest level at 12 hours postoperation and recovered to normal at 48 hours postoperation in 38 patients. The other 9 patients with continuously elevated early cardiac injury markers from postoperation to 48 hours after operation. Of which, 2 cases were death and 7 cases occured severe postoperative adverse events. There's a positive co- relationship between serum early cardiac injury markers' levels and death and severe post-operation adverse events R = 0. 62, P< 0. 001. Conclusion Early cardiac injury markers were elevated after direct version intracardiac surgery and its continuous elevation may indicate major postoperative adverse events.

关 键 词：常温 手术期 心肌损伤 肌钙蛋白T Tn-T 

分 类 号：R542.2[医药卫生—心血管疾病]