冠状动脉旁路移植术后心肌缺血损伤的评估

Evaluation of myocardial ischemia after coronary artery bypass graft

目的观察急性心梗及心脏手术后肌钙蛋白(IcTnI)的变化情况,以了解两种情况下影响cTnI升高的机制是否相同。方法检测30例急性心梗(AMI)患者胸痛发作4h、6h、12h、24h、48h、72h、96h及1周时cTnI的变化,以及30例非体外循环冠脉搭桥术(OPCABG)患者术中吻合血管前、关胸即刻(0h)、术后3h、6h、12h、24h、48h、72h、96h以及术后1周cTnI的变化情况,将术后患者分为术后心梗患者(PMI)、术后心绞痛患者以及术后无症状患者,制作变化曲线进行对比。结果术后心梗患者cTnI变化曲线上升支较急性心梗组陡直,下降支较急性心梗组变化平缓,表明术后cTnI清除速度下降。术后心绞痛患者与术后无症状患者,cTnI均有不同程度的升高,但组间的cTnI差异无统计学意义。术后无症状患者与AMI组比较,峰值提前。结论根据术后cTnI的变化,进行危险分层,评估预后,分层管理,指导临床术后处理,并作为治疗效果的监测途径,提高手术效果,改善患者预后。

Objective To ascertain whether the same processes influence troponin I elevation in the conditions of acute myocardial infarction and cardiac surgery.Methods Plasma cTnI was measured before anastomosis of blood vessel,immediately after operation and 3h,6h,12h,24h,48h,72h,96h and 1 week after operation in thirty patients undergoing coronary artery bypass graft,and thirty patients of acute myocardial infarction in the same time points.Results The up-slope of the cardiac surgery curve was much steeper than that of acute myocardial infarction,its down-slope was significantly more gentle than that of acute myocardial infarction.Conclusion According to the change of cTnI,to evaluate prognosis,make level administration,to direct the management after operation,improve the effects of operation and prognosis of patient.