乌司他丁对全身麻醉下行颈动脉内膜切除术患者血清心肌肌钙蛋白I的影响

Effect of ulinastatin on cardiac troponin I in patients underwent carotid endarterectomy under general anesthesia

目的：探讨乌司他丁对全身麻醉下行颈动脉内膜切除术（ CEA）患者术后血清心肌肌钙蛋白I（ cTnI）的影响。方法将2011年1月-2012年3月40例症状性颈动脉重度狭窄,于全身麻醉下行单侧CEA的患者按照随机数字表法分为乌司他丁组和对照组,每组20例。乌司他丁组在麻醉诱导前,经静脉给予乌司他丁50万U,给予对照组等量等渗盐水。分别于术前、术后第1、2、3天检测患者血清cTnI的浓度。心肌损伤定义为cTnI峰浓度〉0．04μg/L。结果乌司他丁组术前及术后第1、2、3天血清cTnI水平分别为中位数（M）0．00（0．000．03）、0．07（0．001．45）、0．01（0．001．21）及0．05（0．000．89）μg/L；对照组分别为0．00（0．000．01）、0．00（0．001．42）、0．00（0．001．39）及0．00（0．001．24）μg/L。对照组6例（30%）与乌司他丁组11例（55%）患者术后第1天发生心肌损伤,组间差异无统计学意义（ P〈0．05）。所有 cTnI水平升高患者的cTnI高峰出现在术后第1天,但均未达到提示患者发生心肌梗死的水平（〉1．5μg/L）。结论乌司他丁不能降低全身麻醉下CEA患者术后的血清cTnI水平,对CEA患者是否具有心肌保护作用,需更多样本加以证实。

Objective To investigate the effect of ulinastatin on postoperative cardiac troponin I （ cTnI） in patients underwent carotid endarterectomy （ CEA） under general anesthesia. Methods Forty patients with severe symptomatic carotid artery stenosis underwent unilateral CEA under general anesthesia from January 2011 to March 2012 were divided into either a ulinastatin group or a control group according to a random number table （ n=20 in each group） . Patients in the ulinastatin group received 500 000 U of ulinastatin via veins before induction of anesthesia. The patients in the control group were given the same amount of isotonic saline. The serum concentrations of cardiac troponin I （ cTnI ） were detected before surgery and at day 1,2,and 3 after procedure. Myocardial injury was defined as the cTnI peak concentration〉0. 04μg/L . Results The levels of serum cTnI before procedure and at day 1,2,and 3 after procedure in the ulinastatin group were median （M） 0. 00 （0. 00-0. 03） μg/L,0. 07 （0. 00-1. 45） μg/L,0. 01 （0. 00-1. 21）μg/L,and 0. 05 （0. 00-0. 89）μg/L,respectively;those in the control group were 0. 00 （0. 00-0. 01）μg/L,0. 00 （0. 00-1. 42）μg/L,0. 00 （0. 00-1. 39）μg/L,and 0. 00 （0. 00-1. 24）μg/L, respectively. At day 1 after procedure,6 patients （ 30%） in the control group and 11 （ 55%） in the ulinastatin group occurred myocardial injury. There was no significant difference between the two groups （P〈0. 05）. In all the patients with the increased cTnI levels,the peak cTnI occurred at the first day after procedure,however,they did not reach the level （ 〉1. 5μg/L） of indicating patients occurring＆amp;nbsp;myocardial infarction. Conclusion Ulinastatin may not decrease the postoperative serum cTnI levels in CEA patients under general anesthesia. For whether to the CEA patients have myocardial protective effect,more samples are needed to be confirmed.