心肌肌钙蛋白I评价冷氧合血停跳和心脏不停跳的心肌保护效果

Cardiac troponin I in evaluation of myocardial protective effect of cold blood cardioplegia and unarrested heart

目的 探讨冷氧合血停跳和心脏不停跳的心肌保护效果。方法 5 0例心内直视手术病人随机分为冷氧合血停跳组 (Ⅰ组 )和心脏不停跳组 (Ⅱ组 ) ,每组 2 5例 ,分别于术前、术后多个时点采取中心静脉血 ,测定心肌肌钙蛋白I(cTnI)、CK、CK MB ,缺血前后观察心肌超微结构变化。结果 术前两组的cTnI、CK和CK MB均在正常范围内 ,开放主动脉后 1小时至术后 2 4小时达峰值 ,其后缓慢下降 ,术后 2 4小时心脏不停跳组CK水平明显低于冷氧合血组 (P <0 0 5 ) ,各时点cTnI、CK MB水平两组间无显著性差异 (P >0 0 5 ) ,心肌超微结构于体外循环后两组间或与术前比较均无显著性差异 (P >0 0 5 )。结论 cTnI、心肌酶、心肌超微结构的动态变化提示冷氧合血停跳液与心脏不停跳的心肌保护效果相同。

Objective This study was designed to valuate the myocardial protective effect of the cold blood cardioplegia and unarrested heart.Methods 50 patients were randomly divided into two groups,group Ⅰ(cold blood cardioplegia, n= 25),group Ⅱ(unarrested heart, n= 25).Blood samples were obtained before and after operation.Cardiac troponin I(cTnI)?CK?CK MB were measured.Myocardial samples were obtained to observe myocardial ultrastructure at 10min before aorta clamping and 30min after aotra unclamping.Results cTnI,CK and CK MB were normal before operation,and increased remarkablely 1 hour after aotra unclamping in two groups.The top was in a period of 1h after aotra unclamping to 24hrs after operation and decreased progressively to the normal.The serum CK was significantly lower in group Ⅱ than that in group Ⅰ at 24hrs after operation ( P< 0 05).There were no significant differences in serunm cTnI?CK MB and the myocardial ultrastructure between group Ⅰ and Ⅱ after operation( P> 0 05).And so did the myocardial ultrastructure before and after operation ( P> 0 05).Conclusion This study indicates that myocardial protective effect of the cold blood cardioplegia is similar to that of unarrested heart during CPB.