主动脉冠状动脉旁路移植手术术中检测心肌肌钙蛋白I对术后心脏不良事件的预测价值

Predictive value of cardiac troponin I for adverse outcome in coronary artery bypass surgery

目的测量主动脉-冠状动脉旁路移植(CABG)过程中早期[即心肺分流术(cardiopulmonary bypass,CPB)停止后]cTnI的释放,以了解不稳定心脏功能可能导致的血液动力学恶变及其相关不良后果(adverse outcome,AO)。方法95例CABG患者于诱导麻醉前和CPB终止后采用荧光酶免疫吸附分析仪检测cTnI浓度。结果全组术前平均cTnI水平为(0.04±0.10)ng/L。CPB终止时出现不良后果组的cTnI平均值为(0.90±0.4)ng/L;其他患者为(0.37±0.2)ng/L(P<0.001)。结论CABG过程终止钳cTnI释放可能提示术后的不良后果。手术早期进行血液样本分析cTnI浓度变化可以及时提供结果,为诊断和治疗性干涉血液动力学恶变提供依据。

Objectives Cardiac troponin I （cTnI） is a well-known marker for myocardial damage in patients undergoing aortocoronary bypass grafting （CABG） peaking （6±8）h after aortic declamping, The aim of this study was to evaluate cTnl release in the course of CABG procedures early, i.e. after the cessation of cardiopulmonary bypass （CPB） in order to recognize unstable cardiac function leading to hemodynamic deterioration and resulting in an adverse outcome （AO）. Methods Five-hundred and forty consecutive patients undergone CABG were evaluated for cTnI release immediately prior to the induction of anesthesia （IND） and after termination of CPB （END）. Troponin I was measured with the Stratus CSTM uorometric enzyme immunoassay analyzer （Dade-Behring） running. Results The mean preoperative cTnI level was （0.04±0.10）ng/L for the entire group. The END cTnI level for theAO-group was （0.90±0.4）ng/L; for all other patients, this was （0.37±0.2）ng/L （P〈0.001）. Conclusion cTnl release as determined at the end of CABG procedures represents a strong predictor of an AO after surgery. Analyzing blood sampies for eTnl with an automated device provides for immediate results, so specific diagnostic and therapeutic, interventions can be performed before hemodynamics deteriorate.