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冠状动脉旁路移植手术围术期血清肌钙蛋白T水平的变化 |
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袁训芝 吴安石 肖锋 陆冠宇 柳娟 廉桂青 张晋萍 田鸣 岳云
【摘要】 目的 探讨肌钙蛋白T作为心肌损伤生化标志物的价值。方法 连续选择冠状动脉旁路移植手术(CABG)患者22例，分别于麻醉前、体外循环(CPB)前、CPB结束后即刻和CPB后24小时，抽取静脉血4ml，用于肌酸激酶(CK)、肌酸激酶-MB(CK-MB)和心肌肌钙蛋白T(cTnT)的测定。结果 CPB前CK、CK-MB和сTnТ的中位数皆在正常范围内，CPB后即刻和24小时均显著性增高，CK以术后24小时最为明显，其余2指标以术后即刻最为明显。CK和cTnT升高的程度无显著性差别，明显高于CK-MB，但cTnT具心肌特异性。结论 cTnT作为心肌损伤标志物，与CK-MB比较，具有在血循环出现早、敏感和特异的特点，可作为监测CABG患者围术期心肌损伤较为可靠的指标。
【关键词】 心肌 病理学 冠状动脉分流术 肌钙蛋白
Monitoring cardiac troponin T as a marker of perioperative myocardial injury in patients undergoing coronary artery bypass graft surgery
YUAN Xunzhi WU Anshi，XIAO Feng，et al.
Department of Anesthesiology，Beijing Red Cross Chaoyang Hospital，Beijing 100020
【Abstract】 Objective To determine the value of serum cardiac troponin T(cTnT) as a marker of myocardial cell damage in patients undergoing coronary artery bypass graft surgery (CABG).Methods Twenty-two patients with intractable unstable angina，scheduled for CABG，were selected consecutively.Serum CK，CK-MB and cTnT concentrations were measured before，immediately after and 24h after cardiopulmonary bypass (CPB).Results The median value of CK，CK-MB and cTnT levels were all in normal range before CPB，and increased significantly immediately after and 24h after CPB.CK level reached the highest value 24h after CPB，whereas CK-MB and cTnT levels did immediately after CPB.The degree of elevation was not different between CK and cTnT，which was significantly higher than that of CK-MB but cTnT was more specific than CK and CK-MB.Conclusion cTnT is more sensitive and specific than CK and CK-MB in predicting early myocardial injury as an reliable perioperative monitoring indicator in patients undergoing CABG.
【Key words】 Myocardium Pathology Coronary artery bypass Troponin
冠状动脉旁路移植手术(CABG)患者冠脉病变复杂，手术创伤大，术中体外循环和手术操作都可致心肌发生缺血或损伤，因此，围术期心肌缺血或损伤的监测非常重要，影响手术的成败和患者的远期预后，以往常将肌酸激酶(CK)、肌酸激酶-MB(CK-MB)作为心脏围手术期心肌损伤的监测指标［1］，但由于两者的敏感性或特异性较低，实际应用中并不十分理想。有[1] [2] 下一页
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