肌钙蛋白Ⅰ评价心脏矫治术心肌损伤的作用

Diagnostic Value of Cardiac Troponin I in Estimating Myocardium Injury of Open Heart Surgery

目的观察先天性心脏病心内直视矫治术患儿围手术期血清肌钙蛋白Ⅰ（cTnⅠ）和肌酸激酶同工酶（CK—MB）的浓度变化，判断cTnⅠ在评价心肌损伤中的应用价值。方法40例先天性心脏病小儿患者随机分为心脏不停跳组（组Ⅰ，n=20）和冷晶体心脏停搏组（组Ⅱ，n=20），全部患者分别于切皮前和开放升主动脉后（组Ⅰ为缝合右房壁后）1、8～12、24、48、72和96h取患者中心静脉血，测定cTnⅠ和CK—MB的血清浓度。结果两组患者术后cTnⅠ和CK—MB的血清水平均不同程度升高，cTnⅠ血清浓度术后24h达峰值，术后各时点组ⅡcTnⅠ明显高于组Ⅰ（P〈0．05）。两组患者血清CK-MB浓度于术后8～12h达峰值，术后1、8～12、24、48h组ⅡCK-MB浓度明显高于组Ⅰ（P〈0．05）。结论cTnⅠ作为判断心肌损伤的指标，较CK-MB更为特异，更能准确反映心脏直视手术围术期心肌损伤程度，可作为评价心脏直视术心肌损伤程度、监测病情、观察疗效和评估预后的重要指标。不停跳术式在保护心肌损伤方面可能优于心脏停搏术式。

Objective To observe the changes of serum cardiac troponin Ⅰ（cTnⅠ） and the changes of creatin kinase MB （CK-MB） at perioperation for the children with congenital cardiac diseases, and to estimate the clinical value of cTnI in reflecting myocardium injury in open heart surgery with cardiac pulmonary bypass. Methods Forty child patients undergoing correction operation of congenital cardiac defects were randomly divided into two groups： group Ⅰ（beating heart, n = 20） and group Ⅱ （ cold crystalloid cardioplegia, n = 20）. Central venous blood samples were taken at different times at perioperation to measure serum cTnⅠ and activities of CK-MB in the two groups. Results Serum cTnⅠ and activities of CK-MB were increased in various degrees at postoperation in each group. CK- MB reached the peak value at 8 h to 12 h, while cTnⅠ reached the peak value at 24 h postoperatively. Levels of cTnⅠ were significantly higher in group Ⅱ than those in group Ⅰ in all time spots at postoperation （P 〈 0.05）, and the activities of CK-MB were significantly higher in group Ⅱ than those in group Ⅰ from 1 h to 48 h on four spots postoperatively （P 〈0.05）. Conclusion The measurement of cTnⅠ is more sensitive and specific than that of CK-MB in evaluating injury in open heart surgery, cTnⅠ measurement can accurately reflect heart injury and evaluate curative effect. The level of cTnⅠ in beating heart group is lower than that of cold crystalloid cardioplegia group,which indicates that the method of beating heart is better than that of cold crystalloid cardioplegia in protecting the heart in open heart surgery injury.