心肌肌钙蛋白Ⅰ在体外循环心内直视手术中对心肌损伤的监测作用

Application of cardiac troponin Ⅰ to the diagnosis of myocardial injury in open heart surgery with cardiopulmonary bypass

目的 探讨心肌肌钙蛋白Ⅰ (cTnⅠ )对先心病心内直视手术围体外循环期心肌缺血再灌注损伤的监测价值。方法 选择 2 0例拟行房或室间隔缺损修补术的先心病病人 ,随机分为对照组 (C组 )与乌司他丁组 (U组 ) ,每组 10例。分别于围术期多个时点采取桡动脉血 ,测定血浆肌钙蛋白Ⅰ (cTnⅠ )、肌酸激酶 (CK)及同工酶 (CK MB)浓度。结果 两组病人术前血浆cTnⅠ、CK和CK MB浓度均在正常范围内 ,且组间比较无差异。C组血浆cTnⅠ浓度在T3 、T4和T5时点都有显著升高 (P <0 0 0 1) ,于T4时点达峰值 ,T5时点开始下降。U组血浆cTnⅠ浓度在T3 、T4时点明显升高(P <0 0 0 1) ,于T5时点已下降至正常水平 ;在T3 、T4及T5时点U组cTnⅠ明显低于C组 (P <0 0 5 )。C组与U组血浆CK和CK MB浓度 ,在T2 、T3 、T4和T5时点都明显升高 (P <0 0 0 1) ,T2 、T3 及T4时点两组比较无显著性差异 ,至T5时点U组显著低于C组 (P <0 0 5 )。结论 cTnⅠ作为心肌损伤标志物 ,与CK、CK MB比较敏感性和特异性更高 ,是心内直视手术围术期检测心肌损伤的可靠指标。

Objective To evaluate the clinical value of cardiac troponin Ⅰ(cTnⅠ) in the diagnosis of myocardial ischmic reperfusion injury in open heart surgery with cardiopulmonary bypass(CPB). Methods Twenty patients undergoing atrioseptopexy or ventriseptopexy under CPB were randomly divided into two groups( n= 10):control group and ulinastatin group.Plasma levels of cardiac troponinⅠ(cTnⅠ),creatine phosphokinase(CK) and creatine phosphokinase isoenyme(CK MB)were measured before CPB(T 1),at the onset of aorta unclamping(T 2),30min after unclamping(T 3),4h after weaning from CPB(T 4) and 24h after weaning from CPB(T 5).Results The plasma cTnⅠ,CK and CK MB levels were normal before CPB and there were no significant differences in cTnⅠ,CK and CK MB between two groups.The plasma level of cTnⅠ at T 2,T 3,T 4 and T 5 in group C was higher than that at T 1( P< 0 001),and reach the peak level at T 4,then decreased at T 5.In group U the plasma level of cTnⅠ at T 3 and T 4 was higher than that at T 1( P< 0 001),and decreased to normal at T 5.cTnⅠ were lower at T 3,T 4 and T 5 in group U than that in group C( P< 0 05).The plasma levels of CK and CK MB at T 2,T 3,T 4 and T 5 were higher than that at T 1( P< 0 001)in two groups.There were no significant differences in plasma CK and CK MB level between two groups at T 2,T 3 and T 4;but they were lower in group U than in group C at T 5( P< 0 05).Conclusion cTnⅠ as a marker of myocardial injury is more sensitive and specific than CK and CK MB,it is the reliable method for the diagnosis of myocardial injury during open heart surgery. [