缺血性心脏病患者非心脏手术围术期心肌肌钙蛋白I的动态变化

Preliminary study on perioperative release of cardiac troponin I in ischemic heart disease patients undergoing non-cardiac surgery

目的 观察心肌肌钙蛋白I(cTnI)在缺血性心脏病患者非心脏手术围术期的动态变化与临床预后的关系。方法 10 0例ASAⅡ～Ⅲ级择期非心脏手术患者 ,诊断合并缺血性心脏病 ,分别于术前、麻醉诱导后、术毕和术后 6h进行血清cTnI的动态检测 ,记录围术期心电改变和心脏事件的发生情况。以术前cTnI≥ 0 3μg/L为阳性 ,将病人分为阴性组和阳性组。 结果 两组患者术毕及术后 6hcTnI均显著高于术前 (P <0 0 5或P <0 0 1) ;术毕及术后 6hcTnI阳性组显著高于阴性组(P <0 0 5 )。阳性组术后心电改变发生率明显高于阴性组 (P <0 0 5 ) ;术后心脏事件发生率亦显著高于阴性组 (P <0 0 1)。结论 cTnI是判断心肌损伤的可靠指标 。

Objective To investigate the relationship between perioperative release of cardiac troponin I(cTnI)and the clinical prognosis.Methods 100 ischemic heart disease patients undergoi-ng selective non-cardiac surgery were allocated into two groups:the positive group(with cTnI≥0.3 μg/L before operation)and the negative group(with cTnI<0.3 μg/L before operation).Venous blood samples were taken before operation,after induction of anesthesia,at the end of surgery and 6 h after operation for determination of cTnI.Results cTnI increased significantly at the end of surgery and 6 h after surgery compared with that before operation in both groups(P<0.05,P<0.01).The rate of ECG change and cardiac events of positive group was markedly more than that of negative group at the same time points(P<0.05 or P<0.01).Conclusion cTnI is a reliable and sensitive index for detecting myocardial damage perioperatively.Ischemic heart diease patients with increased cTnI before non-cardiac operation tend to have more heart events postoperatively.