腹主动脉下段球囊临时阻断术时钙蛋白T水平的变化及临床意义

Change and Clinical Significance of the Changes of TNT in Ischemia-reperfusion Injury of Lower Abdominal Aorta

目的:探讨腹主动脉下段球囊临时阻断术时钙蛋白T(TnT)水平的变化及临床意义。方法:回顾性分析2015年5月至2016年12月我院收治的58例难治性盆腔类手术患者的临床资料,包括骨盆骨折11例、凶险性前置胎盘并发胎盘植入22例、骶骨肿瘤切除术12例、盆腔肿瘤切除术13例。以上全部操作均给予腹主动脉下段球囊临时阻断术。分别于术前、球囊阻断时、术后的血液样本对钙蛋白T(TnT)进行检测。手术时间2~5 h,平均3.6 h。结果:术前,所有患者血清TnT水平为(90±5)pg/m L。阻断时,血清TnT升高至(109±3)pg/m L,与术前比较差异有统计学意义(p<0.05)。解除阻断后1小时,TnT升高至(113±2)pg/m L;解除阻断后2小时TnT较阻断时升高至(115±3)pg/m L,较阻断前明显升高,差异有统计学意义(p<0.05)。解除阻断后6小时,TnT较阻断时下降(95±5)pg/ml,较阻断后2 h明显下降并恢复至正常值,差异有统计学意义(p<0.05)。结论:腹主动脉下段球囊临时阻断术不可避免引起心肌细胞不同程度的缺血再灌注损伤,但是此类损伤不大,为一过性、可代偿的损害。

Objective： To investigate the changes and clinical significances of TnT during the temporary balloon occlusion of the lower abdominal aorta. Methods： The clinical data of 58 patients with intractable pelvic surgery from May 2015 to December 2016,including11 cases of pelvic fracture, 22 cases of placenta previa complicated with placenta accreta, 12 cases of sacral tumor resection, 13 cases of pelvic tumor resection were retrospectively analyzed. All the patients were given temporary balloon blocking-up of the lower abdominal aorta. The serum level of TnT were detected preoperation, balloon blocking-up and postoperation. The operation time was 2 ~5 h, with an average of 3.6 H. Results： Before operation, the level of serum TnT of all patients was（90 ±5） pg/m L. When blocking, the serum TnT increased to（109 ±3） pg/m L, which was significantly higher（P〈0.05）. After 1 hour, the TnT increased to（113 ±2） pg/m L,and the TnT increased to（115 ±3） pg/m L at 2 hours after the blockade（P〈0.05）. After 6 hours of interruption, TnT decreased（95 ±5）pg/ml compared with blocking, and significantly decreased and recovered to normal value compared with 2 h after blocking（P〈0.05）.Conclusion： Temporary occlusion of the inferior segment of the abdominal aorta could inevitably cause different degrees of ischemiareperfusion injury of the myocardial cells, but this kind of injury was a transient and compensable damage.