cTnI、hFABP在不停跳冠状动脉旁路移植术68例围术期变化的研究

Study on perioperative changes of cTnI,hFABP in patients undergoing off-pump coronary artery bypass grafting

目的:评价心肌特异性脂肪酸结合蛋白(hFABP)在不停跳冠状动脉旁路移植术(OPCABG)围术期诊断心肌缺血损伤的效率。方法:随机择期OPCABG患者68例(ASAⅡ～Ⅲ),在麻醉诱导前(T0)、术中吻合血管(T1)、手术结束(T2)、术后6h(T3)、18h(T4)、36h(T5)时间位点测定肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶(CK-MB)及血清hFABP浓度,并观察血流动力学的变化。结果:有12例患者(17.6%)在手术中出现ECG的ST段上升>0.1mV或肺毛细血管楔压(PCWP)>18mmHg的心肌缺血损伤,其血清hFABP、cTnI、CK-MB系列浓度均保持在较高的水平,血清hFABP浓度的峰值比cTnI、CK-MB浓度的峰值均高并提前数小时出现;而56例患者(82.4%)血清hFABP、cTnI、CK-MB系列浓度均保持在较低的水平。结论:与cTnI和CK-MB相比,hFABP对OPCABG围术期心肌缺血损伤具有更快速、更易于诊断的价值。

Objective： To explore the sensitivity of myocardial damage in patients undergoing off-pump coronary artery bypassgrafting between serum hFABP and cTnI. Methods： sixty-eight consecutive patients undergoing OPCABG were included in a randomized study using standardized operative procedures and myocardial protection. Serial blood samples were taken preoperatively, during anastomoses, in the end of operation, 6 h, 18 h and 36 h postoperatively and were tested for hFABP,troponin（cTnI）,creatine kinase isoenzyme （CK-MB）. Results： Twelve cases （17.6%） were found myocardial injury during the OPCABG by ECG or PAP. Their serial serum hFABP,cTnI,CK-MB were all in higher levels than those without myocardial injury. Peak serum level of hFABP was higher and appeared earlier than those of cTnI,CK-MB. Conclusion： The above results show that serum hFABP is an earlier and more sensitive biochemical marker for the diagnosis of myocardial injury in patients undergoing OPCABG.