血清心肌标记物在室间隔缺损患儿介入治疗中的应用研究

Application of serum myocardial markers to interventional treatment of children with ventricular septal defect

目的 探讨血清心肌标记物在室间隔缺损介入治疗前后的变化情况。方法 选取接受室间隔缺损介入治疗的69例患儿作为研究对象。分析比较患儿治疗前后的血清心肌标记物水平,如血清肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)、超敏C反应蛋白(hs-CRP)。结果 69例患儿中67例介入治疗成功,成功率为97.10%,手术时间为(82.15±26.37)min。1例患儿因封堵器不能完全覆盖缺损而收回封堵器,另1例在建立轨道时出现三度房室传导阻滞而放弃封堵。与术前比较,室间隔缺损患儿术后6hcTnI明显升高,术后12h开始下降,差异均有统计学意义(P<0.05);术后48hcTnI水平与术前相比,差异无统计学意义(P>0.05)。术后6h、12h、24h、48hCK、CK-MB、LDH、AST水平与术前相比,差异无统计学意义(P>0.05)。术后6h、12h、24h、48hhs-CRP水平明显高于术前,差异均有统计学意义(P<0.05)。结论 室间隔缺损介入治疗后患儿cTnI和hs-CRP水平呈现一定的波动,可能与介入治疗的预后有关,需进一步的随访研究进行验证。

Objective To investigate the changes of serum myocardial markers before and afteRinterventional treatment of ventriculaRseptal defect. Methods Sixty-nine children receiving interventional treatment of ventriculaRseptal defect were enrolled as the subjects. Serum myocardial markers of the children before and afteRtreatment were analyzed and compared, such as serum troponin I (cTnI), creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and high-sensitivity C-reactive protein (hs-CRP). Results Of the 69 children, 67 children achieved successful interventional treatment, with a success rate of 97.10% and an operation duration of 82.15±26.37 minutes. OccludeRwithdrawal was performed in one child because the occludeRcould not completely coveRthe defect, and anotheRcase gave up occludeRuse due to a third-degree atrioventriculaRblock when the orbit was established. Compared with the preoperative level, cTnI level increased significantly at 6 hours afteRoperation in children with ventriculaRseptal defect and began to decrease at1 2 hours afteRoperation, presenting statistically significant differences ( P <0.05 );there was no statistically significant difference between the cTnI level at 48 hours afteRoperation and the preoperative level ( P >0.05). The postoperative 6-,1 2-, 24- oR48-houRCK, CK-MB, LDH, oRAST level did not statistically diffeRfrom the preoperative level ( P >0.05). The postoperative 6-,1 2-, 24- and 48-houRhs-CRP levels were significantly higheRthan that before operation, presenting statistically significant difference ( P <0.05 ). Conclusion The levels of cTnI and hs-CRP show a certain fluctuation in children afteRinterventional treatment of ventriculaRseptal defect, which may be related to the prognosis of interventional therapy. FurtheRfollow-up studies are needed foRverification.