常温不停跳心内直视手术后不同时间心肌损伤标志物水平对预后的预测价值

Changes of post-operative cardiac injury markers and its clinical significance in beating heart direct version intracardiac surgery

目的 探讨常温不停跳心内直视手术后心肌损伤标志物的动态变化及其对预后的预测价值。方法 选择 4 8例择期二尖瓣置换术病人 ,分别于术前、术后即刻、术后 12h、2 4h及 4 8h等时点取静脉血检测C反应蛋白(CRP)、肌酸激酶同工酶 (CK MB)、肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)浓度变化 ,同时记录心电图 (ECG)、血流动力学指标及不良事件发生情况。结果 术前所有患者血浆CRP、CK MB、cTnT、cTnI均在正常范围 ,术后即刻上述指标明显升高 (P <0 0 5or 0 0 1) ,术后 12h达峰值 ;12例患者术后 4 8hCRP、CK MB、cTnT、cTnI仍显著高于正常 ,其中 2例死亡 ,7例发生术后低心排和 /或严重心律失常 ,3例发生一过性心律失常 :术后 12hcTnI>10 0 0 μg/L组与cTnI <10 0 0μg/L组严重不良事件发生率分别为 6 6 7%和 12 1%。 结论 常温不停跳心内直视手术后心肌损伤早期标志物明显升高 ,术后 4 8h仍未恢复正常或术后 12hcTnI超过 10 0 0μg/L提示预后不佳。

Objectives To investigate the changes of cardiac injury markers after beating heart direct version intracardiac surgery and its clinical significance. Methods 48 patients undergoing elective direct version intracardiac surgery(mitral valve replacement, MVR) were chosen. Changes of C-reaction protein(CRP),creation kinase MB isoform(CK-MB),cardiac troponin T (cTnT) and cardiac troponin I(cTnI) were detected at different time points. Electrocardiogram(UCG),hemodynamic parameters and clinical outcomes were recorded simultaneously. Results The cardiac injury markers were significantly elevated at the early time after the operation, reached the highest level at 12 hours postoperation. Among the 12 patients with abnormal cTnI at 48 hours after operation,2 died and 7 had severe post-operation adverse events. The rate of severe post-operation adverse events in patients with 12 hours post-operative cTnI over or below 10.00 μg/L were 66.7% and 12.1% respectively. Conclusions Early cardiac injury markers were elevated after direct version intracardiac surgery. Patients with elevated cardiac injury markers at 48 hours after operation or cTnI over 10.00 μg/L at 12 hours post-operation may indicate major post-operative adverse events.