介入治疗前后室间隔缺损患儿血清心肌肌钙蛋白I水平的变化

Change of Serum Cardiac Troponin I during Transcatheter Interventional Therapy on Children with Ventricular Septal Defect

目的观察VSD患儿介入治疗前后血清心肌肌钙蛋白I(cTnI)的动态变化,并分析其影响因素。方法选择2008年1月-2011年6月在河北医科大学第一医院先天性心脏病诊疗中心住院并成功施行介入治疗的VSD患儿116例作为研究对象。男54例,女62例;年龄(8.324±4.367)岁。于介入术前,术后6 h、12 h、24 h和5 d分别测定其血清cTnI水平,比较不同时间点间血清cTnI水平的差异,并应用多元线性回归分析分析其血清cTnI水平的影响因素。结果患儿术前血清cTnI水平均处于正常范围,血清cTnI高峰在术后6 h出现,术后5 d恢复正常;不同时间点间血清cTnI水平比较差异均有统计学意义(Pa<0.05);血清cTnI峰值水平与年龄、肺动脉压、介入操作时间、释放封堵器次数、封堵器大小、造影剂剂量具有相关性。结论介入治疗儿童VSD可引起血清cTnI升高,其升高程度与患儿年龄、肺动脉压、介入操作时间、释放封堵器次数、封堵器大小、造影剂剂量有关;介入治疗VSD仅引起儿童心肌可逆性微损伤,是安全、有效、创伤小的治疗方法。

Objective To investigate the changes of serum cardiac troponin I（cTnI） during interventional therapy on ventricular septal defect （VSD） in children. Methods One hundred and sixteen children with VSD, 54 cases were male and 62 cases were female, aged （8. 324 ~ 4. 367 ） years old, were treated with occlnders successfully in Diagnosis and Treatment Center of Congenital Heart Disease, the First Hospital of Hebei Medical University from Jan. 2008 to Jun. 2011. The levels of serum cTnI were measured before intervention and 6 hours, 12 hours,24 hours and 5 days after intervention. The serum cTnl levels of different time were compared, multiple liner regression analysis was used to investigate the influence factors for serum cTnI. Results The levels of serum cTnI were all normal before intervention,the peak level of cTnI occurred at 6 hours after intervention, and all the patients had a normal serum cTnl level again 5 days later. There were statistically significant difference among the cTnl levels at different times（ Pa 〈 0.05 ）. The cTnI peak levels con＇elated with age ,pulmonary artery pressure, operation duration,releasing times of occluder devices, size of occluders and the dose of contrast agent. Conclusions Interventional therapy on VSD of children can result in the increasing of serum cTnI level, cTnl peak level correlates with age, pulmonary artery pressure, operation duration of intervention application, releasing times of the occluders, size of occluders and the dose of contrast agent. Interventional therapy on VSD of children may result in reversible, minor myocardial damage.and it is a safe.effective and minimally invasive treatment method.