非体外循环冠状动脉旁路移植术围术期cTnI、CK及CK-MB的变化

Changes of troponin I, creatine kinase and creatine kinase-MB activities in serum during off-pump coronary artery bypass grafting

目的 :通过对非体外循环冠状动脉旁路移植术 (OPCABG)患者 ,围手术期血清心肌肌钙蛋白 I(c Tn I)、肌酸磷酸激酶 (CK)、肌酸磷酸激酶同工酶 MB(CK- MB)变化的观察 ,探讨 OPCABG围手术期心肌损伤的情况。方法 :选择 2 0例全麻常温下进行 OPCABG患者及 2 0例同期行肺叶切除术患者 (对照组 ) ,麻醉诱导气管插管后以微量输液泵持续输注异丙酚、利多卡因复合液 ,并间断静脉注射芬太尼和哌库溴铵维持麻醉。在麻醉诱导前、术后 1h、2 4h、4 8h4个时间点抽取血样测定 c Tn I、CK、CK- MB值。结果 :所有患者手术经过及术后恢复顺利 ,OPCABG组无一例转为体外循环。两组患者术前 CK、CK- MB均在正常范围 ,术后 1h开始升高 ,术后 2 4 h达峰值 ,与麻醉前比较 ,均 P<0 .0 1;术后 4 8h明显下降 ,但仍高于麻醉前水平 (P<0 .0 1)。 4个时间点两组 CK、CK- MB值相比 ,差异无显著性。OPCABG组 c Tn I值与术前比较 ,术后 1h开始升高 (P<0 .0 1) ,2 4 h达峰值 (P<0 .0 1) ,术后 4 8h有所下降 ,但仍高于麻醉前水平 (P<0 .0 1) ;而肺叶切除组术后 c Tn I值始终不高。术前、术后 1h两组 c Tn I值差异无显著性 ,但 OPCABG组术后 2 4 h、4 8h值均明显高于肺叶切除组 (P<0 .0 1)。手术全程及术后 4 8h动态心电图未发现心肌梗死 ,血?

AIM: To investigate the changes of cardiac troponin I (cTnI), creatine kinase (CK) and creatine kinase-MB (CK-MB) activities in serum during off-pump coronary artery bypass grafting (OPCABG). METHODS: Twenty ASA Ⅰ~Ⅲ patients undergoing OPCABG were in Group Ⅰ. Twenty ASA Ⅰ~Ⅱ patients undergoing pulmonary lobectomy were chosen to heath control (Group Ⅱ). Left radial artery was cannulated for intra-arterial pressure monitoring before anesthesia. Right internal jugular vein was cannulated for fluid administration and CVP monitoring. Anesthesia was induced with midazolam 0.05~0.1 mg·kg -1 , fentanyl 5~10 μg·kg -1 , arduan 0.12 mg·kg -1 , lidocaine 1~2 mg·kg -1 and maintained with propofol and lidocaine intravenous infusion at a rate of 3~5 mg·kg -1 ·h -1 , supplemented with intermit intravenous boluses of fentanyl and arduan. After tracheal intubation, the patients were mechanically ventilated with 100% oxygen and P ET CO 2 was maintained at 30 mm Hg. Serum samples were collected for estimation of CK, CK-MB and cTnI activities at preoperative, 1 hour, 24 hours, 48 hours postoperative. RESULTS: CK, CK-MB activities at 1 hour, 24 hours, 48 hours postoperative in two groups were significantly higher than preoperative (P<0.01). But there were no difference in the same time between two groups. CTnI activities at 1 hour, 24 hours, 48 hours postoperative were significantly higher than preoperative in Group Ⅰ (P<0.01), but cTnI activities in Group Ⅱ were in normal activities. There were no signs of myocardial infarction in electrocardiogram during the procedure and at 2 days postoperative in two groups. All patients recovered uneventfully. CONCLUSION: There are myocardial injury in OPCABG, how to alleviate its injury during OPCABG is still a work.