心脏手术围术期心肌肌钙蛋白T变化的临床观察

目的 :探讨心肌肌钙蛋白T(CTnT)对心脏手术围术期心肌损伤的判定价值。方法 :5 0例患者按病种分成 3组 ,组 1:15例风湿性心脏瓣膜病患者 ;组 2 :2 0例先天性心脏病患者 ;对照组 :15例食管或肺肿瘤患者 (开胸非心脏手术患者 )。分别于术前、术后即刻、术后 2 4h抽取静脉血 3ml,用于肌酸激酶 (CK )和心肌肌钙蛋白T(CTnT)的测定。其结果结合临床资料和心电图分析比较。结果 :组 1和组 2 (心脏手术 )术前CTnT、CK测定值均在正常范围 ,与对照组 (开胸非心脏手术患者 )相比无明显差异 (P >0 0 5 )。组 1和组 2CTnT、CK值与术后即刻、术后 2 4h均显著升高 (P <0 0 1) ,但CTnT术后即刻、术后 2 4h组 1显著高于组 2(P <0 0 1) ;CK值于术后即刻组 1高于 2组 (P <0 0 5 ) ,于术后 2 4h组 1显著高于组 2 (P <0 0 1)。组 1和组 2术后 2 4hCTnT测定值与主动脉阻断时间呈正直线相关。对照组术前、术后的CTnT值均为正常 ,而CK值术后部分患者升高。结论 :CTnT判定心脏手术围术期心肌损伤的敏感性及特异性明显优于CK ,CT nT浓度反映了心肌损害的程度 ,CTnT对围术期心肌缺血损伤的诊断、预后的评价具有重要临床价值

Changes of Perioperative Cardiac Troponin T in Cardiac Operations

Objective:To evaluate the clinical effect of cardiac troponin T (CTnT) on the diagnosis of myocardial ischemic injury.Method:50 patients were divided into 3 groups:group1:15 rheumatic valvulopathies;group 2:20 congenital heart diseases;control group:15 operative cases of lung or esophageal tumors.The levels of Serum CK and CTnT were measured before,immediate and 24 hours after cardiac operation.The results Combined with clinical data and electrocardiogram were compared and analyzed.Result:The CTnT and CK levels of group 1 and group 2 were normal preoperation,Showing no difference from those of control group (P<0.05),but significantly higher immediate and 24 hours postoperation (P<0.01).The CTnT level of group 1 was significantly higher than that of group 2 immediate and 24 hours postoperation (P<0.01).While the CK level of group 1 was higher than that of group 2 (P<0.05)immediate postoperation,and significantly higher 24 hours postoperation (P<0.01).There was positive linear correlation between aorta cross-clamping time and CTnT level both in group 1 and 24 hours of postoperation.The CTnT level in control group were normal pre and postoperation,while the CK level increased only in some patients.Conclusion:CTnT is more sensitive and charactersitic index of myocardial injury perioperation than CK,The level of CTnT reflects the degree of myocardial injury.It is valuable in diagnosis and prognosis of perioperative myocardial ischemic injury.