肌钙蛋白对心脏外科手术后急性心肌梗死的诊断价值

Discussing the diagnostic value of troponin in the acute myocardial infarction after cardiac surgery

目的 探讨肌钙蛋白对心脏外科手术后急性心肌梗死的诊断价值.方法 采用前瞻性研究方法,选择134例心脏手术患者作为观察组,同期36例胸科手术患者作为对照组,两组患者术后持续心电监护,检测肌钙蛋白I,并对结果进行比较.结果 两组麻醉前肌钙蛋白I比较差异无统计学意义（P＞0.05）.观察组术后4h肌钙蛋白I为（13.010±14.829） μg,/L,与对照组的（0.019±0.007） μg/L比较差异有统计学意义（P＜0.05）.观察组发生急性心肌梗死1例,其肌钙蛋白Ⅰ＞40.000 μg/L.结论 心脏外科手术后早期绝大部分患者的肌钙蛋白明显增高,根据肌钙蛋白诊断术后急性心肌梗死的假阳性率较高,有待更多循证医学证据制定肌钙蛋白对心脏外科手术后急性心肌梗死的诊断标准.

Objective To research the diagnostic value of troponin in the acute myocardial infarction after cardiac surgery.Methods The prospective study method was used.One hundred and thirtyfour patients of cardiac surgery were selected as observation group,36 patients of thoracic surgery were selected as control group.All the patients were given continuous electrocardiogram monitoring and measured troponin I,and the results were compared between the 2 groups.Results There was no statistical difference in the troponin I before anesthesia between the 2 groups （P 〉 0.05）.The troponin I 4 h after surgery was （13.010 ± 14.829） μg/L in observation group,（0.019 ± 0.007） μg/L in control group,there was statistical difference （P 〈 0.05）.One case of observation group happened the acute myocardial infarction after cardiac surgery,the troponin I was 〉 40.000 μ g/L.Conclusions The troponin is obviously increased in the early stage in most patients of cardiac surgery,the false positive rate in diagnostic acute myocardial infarction is higher according to the troponin.For troponin,it will need the more evidence of evidence-based medicine to establish the diagnosis of acute myocardial infarction after cardiac surgery.