心肌肌钙蛋白T对冠状动脉旁路移植术患者围术期心肌梗死的诊断意义

目的：观察心肌肌钙蛋白T（cTnT）与肌酸激酶同功酶（CK-MB）在冠状动脉旁路移植（CABG）术围术期变化,比较两者对心肌损伤的诊断差异,研究cTnT对CABG术围术期心肌梗死的诊断意义。方法：连续152例患者在心脏停跳体外循环下行CABG术,平均年龄62.5±20.7（39~80）岁,平均每例移植血管2.7（1~5）支,平均心肺转流（CPB）时间113±54min,平均主动脉阻断时间56±31min。围术期9个时间点取静脉血标本,测定cTnT与CK-MB。结果：cTnT与CK-MB均于主动阻断钳开放后明显升高,开放后10h达峰值。CK-MB术后5d恢复至术前水平,而cTnT术后10d才恢复至术前水平。13例围术期心肌梗死（PMI）患者术后各时间点所测cTnT均显著高于无PMI者,术后10h达峰值,为2.97±1.12μg.L-1,且术后10d仍明显高于正常范围,为0.87±0.31μg.L-1,其中有7例术后因PMI而死亡。而无PMI者,无1例因心脏原因死亡。结论：cTnT与CK-MB在CABG术后前期的动态变化相似,但cTnT高于正常值的持续时间长,对心肌缺血损伤诊断时间窗宽于CK-MB。因此,cTnT诊断心肌损伤的晚期敏感性高于CK-MB。围术期cTnT的检测是诊断PMI高度敏感性指标,也是预测CABG术后发生PMI及预后的可靠指标。     

血清S100A4水平与急性心肌梗死患者预后相关性分析

目的探讨血清钙卫蛋白A4(S100A4)水平对急性心肌梗死(AMI)患者预后的预测价值。方法选取中铁二局集团中心医院2015年6月至2018年6月诊治的128例AMI患者作为研究组,根据患者住院期间和出院后30d主要心血管不良事件(MACE)发生情况分为非MACE组(37例)和MACE组(91例);同时选取64例体检健康人群作为对照组。检测研究对象血清S100A4、B型脑钠肽(BNP)和心肌肌钙蛋白T(cTnT)水平。采用多因素Logistic回归分析MACE发生的危险因素,同时采用受试者工作特征曲线(ROC曲线)分析血清S100A4、BNP和cTnT对AMI患者发生MACE的预测价值。结果非MACE组血清S100A4、BNP和cTnT水平显著性低于MACE组(P<0.05)。受试者工作特征曲线分析显示:S100A4对AMI患者预后的预测价值优于BNP和cTnT。多因素Logistic回归分析显示:年龄(OR=2.90,95%CI 1.24~6.74)、Killip分级(OR=5.02,95%CI 2.53~9.94)、吸烟史(OR=1.67,95%CI 1.07~2.61)、BNP>389.17pg/mL(OR=1.76,95%CI 1.19~2.61)、cTnT>0.93ng/mL(OR=1.61,95%CI 1.05~2.49)、S100A4>120.56pg/mL(OR=1.88,95%CI 1.16~3.02)是AMI患者发生MACE的危险因素。结论 AMI患者血清S100A4水平显著上升,可作为预测AMI患者MACE发生的标志物。     

Long-term outcome of perioperative low cardiac output syndrome in cardiac surgery: 1-year results of a multicenter randomized trial

PurposePerioperative myocardial dysfunction occurs frequently in cardiac surgery, and is a risk factor for morbidity and mortality. Levosimendan has been suggested to reduce mortality of patients with perioperative myocardial dysfunction. However, long-term outcome data on its efficacy in cardiac surgery are lacking.Materials and methodsCardiac surgery patients with perioperative myocardial dysfunction were randomized to levosimendan or placebo, in addition to standard inotropic care. One-year mortality data were collected.ResultsWe randomized 506 patients (248 to levosimendan 258 to placebo). At 1-year follow-up, 41 patients (16.5%) died in the levosimendan group, while 47 (18.3%) died in the placebo group (absolute risk difference −1.8; 95% CI −8.4 to 4.9; P = .60). Female sex, history of chronic obstructive pulmonary disease, previous myocardial infarction, serum creatinine, hematocrit, mean arterial pressure, and duration of cardiopulmonary bypass were independently associated with 1-year mortality.ConclusionsLevosimendan administration does not improve 1-year survival in cardiac surgery patients with perioperative myocardial dysfunction. One-year mortality in these patients is 17%. Six predictive factors for long-term mortality were identified.Study registration numberNCT00994825 (ClinicalTrials.gov).     

Serum cardiac troponin I after conventional and minimal invasive coronary artery bypass surgery.

We evaluated myocardial release of cardiac troponin I (cTnI) in patients treated with conventional coronary artery bypass grafting (CABG), which employs extracorporeal circulation, and different kinds of minimal invasive coronary artery bypass grafting (MICABG), a surgical technique where the operation is performed without extra-corporeal circulation. Furthermore, we evaluated the usefulness of serum cTnI measurement to detect perioperative myocardial infarction (PMI) after coronary artery bypass surgery. Thirty-one patients were included: sixteen underwent CABG, fifteen underwent different MICABG and five patients had PMI. Blood specimens for cTnI measurements were collected up to 72 hours after opening the graft. Aortic cross-clamping time was a minor determinant of myocardial damage; on the other side, the trauma during surgery correlated with the number of involved arteries and with the manoeuvre employed to obtain heart dislocation, and appeared a more important determinant of myocardial damage. In patients with PMI, the cumulative release of cTnI was higher than in patients free from PMI; however, only after 24-72 hours we observed significant differences in serum cTnI values, because the increased perioperative values of cTnI complicated the interpretation of the myocardial status and a single cut-off could not be used to exclude PMI.     

Risk stratification using serum concentrations of cardiac troponin T in patients with end-stage renal disease on chronic maintenance dialysis

BACKGROUND: It has been recently suggested that cardiac troponin T (cTnT) may be more sensitive than troponin I (cTnI) for subclinical myocardial cell injury in patients on chronic dialysis. METHODS: We prospectively compared the predictive value of cTnT with cTnI, atrial (ANP) and brain natriuretic peptide (BNP) in 100 consecutive outpatients on chronic dialysis without acute coronary syndromes over a period of 3 months, and assessed whether the combination of cTnT with clinical information including age, duration of dialysis, and medical histories was useful for risk stratification of these patients. During the 2-year follow-up period, 19 patients died, mostly due to cardiac causes (53%). RESULTS: The area under the receiver operator characteristic (ROC) curve for the cTnT as predictor of both overall and cardiac death was significantly greater than the area under the cTnI curve (p < 0.0001 and p = 0.01), the BNP curve (p < 0.001 and p < 0.01) or the ANP curve (p < 0.0001 and p < 0.005). In a stepwise multivariate Cox regression analysis, only cTnT (p < 0.05 and p < 0.01) and a history of heart failure requiring hospitalization (p < 0.05 and p < 0.005) were independent predictors of both all cause and cardiac mortality. Using parameters of cTnT > or =0.1 microg/l and/or history of heart failure, the overall and cardiac mortality rate for the low risk group (n=66) were 4.5% and 1.5%, respectively, 40% and 16% for the intermediate risk group (n=25), and 67% and 56% for the high risk group (n=9). CONCLUSION: cTnT concentrations offer a higher prognostic accuracy than cTnI, ANP and BNP in patients on chronic dialysis. The combination of elevated cTnT and a history of heart failure may be a highly effective means of risk stratification of these patients.     

Prognostic value of serum concentration of heart-type fatty acid-binding protein relative to cardiac troponin T on admission in the early hours of acute coronary syndrome

BACKGROUND: Heart-type fatty acid-binding protein (H-FABP) is proposed as an early biomarker for acute myocardial infarction (AMI), but its prognostic value is unclear in acute coronary syndrome (ACS). We evaluated the prognostic value of the H-FABP concentration relative to cardiac troponin T (cTnT) in the early hours of ACS. METHODS: Serum concentrations of H-FABP and cTnT were measured on admission in 328 consecutive patients hospitalized for ACS within 6 h after the onset of chest pain [AMI, 241 (73.5%) patients; ST-segment elevation myocardial infarction, 154 (47.0%) patients; and emergent coronary angiography within 24 h after admission, 287 (87.5%) patients]. Cardiac events, which were defined as cardiac death or subsequent nonfatal AMI, were monitored for 6 months after admission. RESULTS: During the 6-month follow-up period, there were 25 cardiac events, including 15 cardiac deaths and 10 subsequent nonfatal AMIs. Stepwise multivariate analyses including clinical, electrocardiographic, and biochemical variables revealed that increased H-FABP (above the median of 9.8 microg/L), but not increased cTnT (above the median of 0.02 microg/L), was independently associated with cardiac events in all patients [relative risk (RR) = 8.96; P = 0.0004], the subgroup of patients with ST-segment elevation myocardial infarction (RR = 11.3; P = 0.02), and the subgroup of patients with unstable angina and non-ST-segment elevation myocardial infarction (RR = 8.31; P = 0.007). The area under the ROC curve was higher for H-FABP than for cTnT (0.711 vs 0.578; P = 0.08), suggesting that H-FABP concentrations have a greater predictive capacity for cardiac events than cTnT. CONCLUSION: Serum H-FABP is a potential independent predictor of cardiac events within 6 months of patient admission and may provide prognostic information superior to cTnT in the early hours of ACS.     

Results of treatment of patients with acute myocardial infarction and high risk of cardiac complications

The authors compare the results of the treatment of 883 patients with acute myocardial infarction (AMI) referred to the group with high risk of cardiac complications based on the TIMI, GRACE, and TIMI Il assessment stratification scales. 487 patients were treated by conservative therapy using anticoagulative (n = 414) or thrombolytic (n = 73)) agents. 396 underwent surgical treatment (coronary artery bypass surgery (101) or percutaneous coronary angioplasty (295)). The mortality rate in the group treated by percutaneous coronary angioplasty was 13.6 (p < 0.001), 7.2 (p < < 0.01) and 3.5 (p < 0.05) times lower than after anticoagulation therapy, thrombolysis and coronary bypass surgery respectively. It is concluded that percutaneous coronary angioplasty has advantages over other modalities for the treatment of patients with acute myocardial infarction and high risk of cardiac complications.     

Analytical and clinical evaluation of troponin I determination on dimension RXL-HM.

The evaluation of cardiac troponin I (cTnI) on the Dimension RxL-HM analyzer is presented. The one-step enzyme immunoassay is based on two cTnI specific monoclonal antibodies. Performed on a separate module of the analyzer, assay-time is 17 minutes. Using as criterion a between-run impression CV <20% the functional limit of detection was set at 0.1 microg/l. Cutoff level for minor myocardial damage of 0.1 microg/l was found. In Duchenne's dystrophy, patients showed increased cardiac Troponin T (cTnT) but no increased cTnI. In patients with a history of coronary heart disease undergoing chronic hemodialysis, cTnT and cTnI were increased. In different patients with submassive pulmonary embolism, increased cTnI was determined. In coronary artery bypass surgery without perioperative myocardial infarction, patients with extracorporeal circulation showed significantly higher cTnI at 24 h after surgery than those with minimal cardiac surgery. In patients with unstable angina, increased cTnI was found more often than on Stratus analyzer. In conclusion, the new assay is a very sensitive cTnI assay, fast and easy to perform in parallel to enzyme and substrate assays.     

血清心肌肌钙蛋白对心肌损伤的临床诊断价值

目的　探讨定量分析肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)对心肌损伤程度评价的临床意义。方法　对80例心肌梗死患[急性心肌梗死(AMI)50例、陈旧性心肌梗死(OMI)30例]、100例心脏手术患、60例非心脏手术患和20例健康人进行了血清cTnT、cTnI、肌酸激酶同工酶(CK—MB)和肌酸激酶(CK)检测。结果　(1)血清cTnT、cTnI、CK—MB和CK检测心肌损伤的敏感度和特异性分别为cTnT(72.4％，100.0％)、cTnI(81.8％，100.0％)，CK—MB(54.6％，87.5％)和CK(64.8％，62.2％)。(2)AMI和心脏手术组cTnT、cTnI、CK—MB和CK四项指标浓度均显高于正常对照组(P＜0.01)。(3)急性心肌梗死组、心脏手术组3h内cTnT和cTnI阳性检出率分别为(50％，56％)和(44％，45％)，明显高于CK—MB(24％，22％)和CK(20％，28％)；急性心肌梗死组、心脏手术组5d后cTnT和cTnI阳性检出率为(70％，66％)和(66％，61％)，而CK—MB仅为(4％，6％)，CK仅为(8％，10％)。结论　血清cTnT、cTnI能确切反映急性心肌梗死、心脏手术等心肌损伤程度，具有较宽的诊断窗口时间，是心肌损伤较敏感和特异的血清标志物。     

Prognostic significance of admission cardiac troponin T in patients treated successfully with direct percutaneous interventions for acute ST-segment elevation myocardial infarction

BACKGROUND: Cardiac troponin T (cTnT) elevations at admission indicate a high-risk subgroup of patients with acute ST-segment elevation myocardial infarction, possibly due to a higher failure rate of reperfusion therapies. OBJECTIVE: We sought to determine the predictive role of admission cTnT in patients with ST-segment elevation myocardial infarction undergoing successful direct percutaneous coronary intervention. METHODS: A total of 218 consecutive patients with ST-segment elevation myocardial infarction were enrolled. Patients were stratified according to admission cTnT and infarct location. They were followed prospectively for short-term and long-term outcomes.RESULTS A positive cTnT (47.7%) was associated with higher mortality rates at 30 days (14.4% vs. 3.5%, p = .003) and 12 months (17.3% vs. 4.4%, p =.007). cTnT allowed discrimination of patients at high and low risk for cardiac death at 30 days and 12 months among anterior (19.2% vs. 7.9%, p = .19, and 25% vs. 13.2%, p = .22, respectively) and, more impressively, among nonanterior acute myocardial infarction (9.6% vs. 1.3%, p = .04, and 11.5% vs. 1.3%, p = .017, respectively). In multivariate analysis, older age, anterior infarct location, and depressed left ventricular function were the most potent independent predictors of future risk. Among clinical variables available at admission, cTnT indicated independently a higher risk of cardiac death (odds ratio, 3.1 [1.07-9.01], p =.038). This increased risk associated with a positive cTnT was almost independent of time delays from onset of symptoms to admission (3.8 vs. 2.3 hrs in cTnT-positive vs. cTnT-negative patients, p <.001). CONCLUSIONS: Admission cTnT is a strong predictor of future cardiac risk in patients with ST-segment elevation myocardial infarction, despite successful restoration of Thrombolysis in Myocardial Infarction grade 3 coronary flow by direct percutaneous coronary intervention.     

Release patterns of CK-MB and mitochondrial CK following myocardial ischaemia

Following myocardial damage as in acute myocardial infarction (AMI) or open heart surgery, the tissue damage might result in a release of mitochondrial CK (CK-MIT). The presence of this CK isoenzyme in serum may be detected after chromatographic separation of CK-activity on Sephacryl S-200. By combining chromatographic separation of CK-MB with immunologic inhibition of CK-M, both CK-MB and CK-MIT can be estimated in serum. Using this procedure changes in enzyme activities were studied in ten patients with AMI and twelve patients subjected to open heart surgery using cardioplegia. Following AMI CK-MB peaked about 24 h after onset of ischaemic symptoms. CK-MIT increased similarly and reached a plateau after 24 h where it remained during an additional 24-36 h. At peak CK-MB concentration, the corresponding CK-MIT activity was about 22% of the CK-MB activity. Following cardiac surgery there was a rapid release of CK-MB with a peak about 5 h after release of aortic cross-clamping, and with a simultaneous CK-MIT activity amounting to 19% of the CK-MB activity. In conclusion, CK-MIT is released into serum following myocardial ischaemia. Its appearance has time characteristics similar to that of other mitochondrial enzymes. The CK-B method does not specifically determine CK-B, but non-CK-M, which in cardiac ischaemia at peak serum CK-MB concentrations includes about 20% CK-MIT.     

Troponin T levels in detection of perioperative myocardial infarction after coronary artery bypass surgery

OBJECTIVES: The present study was designed to evaluate the clinical relevance of serum cardiac troponinT (cTnT) assay in detection of perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG). MATERIALS AND METHODS: The clinical utility of cTnT was compared to that of total CK, CKMB mass, CKMB activity and myoglobin. Serial venous blood samples were obtained before surgery and 4, 8, 16, 24, 48 and 72 hours after aortic unclamping (AU) in 42 patients who underwent CABG. We had 6 PMI patients, 24 patients with minor myocardial damage (MMD) and 12 without ischemic myocardial changes (no IMC). RESULTS: In discriminating no IMC from PMI the diagnostic sensitivity, specificity and the predictive values of cTnT were superior to that of CKMB mass, CKMB activity, myoglobin and total CK during 72 hours after AU. In discriminating MMD from PMI the diagnostic performance for CKMB mass and CKMB activity was superior to that of cTnT during the first 24 hours. After 24 hours the diagnostic performance for cTnT was improved but began to decline for CKMB isoenzymes. The discriminatory power of myoglobin measurements was lower than that of cTnT and CKMB mass. CONCLUSION: Our results indicate that troponin T is an accurate marker for the detection and monitoring of perioperative myocardial damage, especially 24 hours after AU.     

Off-pump strategy in high-risk coronary artery bypass reoperations

OBJECTIVE: To determine the role of off-pump coronary artery bypass grafting in the treatment of patients with severe recurrent angina after coronary artery bypass grafting who are not suitable for percutaneous coronary intervention and are considered too high risk for conventional on-pump revascularization. PATIENTS AND METHODS: All patients who needed single- or double-vessel revascularization at reoperation with a predicted operative mortality of 10% or higher between March 4, 1994, and December 31, 2002, were studied. Risk stratification was performed using both the Parsonnet risk scoring system and the European System for Cardiac Operative Risk Evaluation. Active follow-up by questionnaire investigated major adverse cardiac events. RESULTS: This study consisted of 84 patients with a median age of 69 years (interquartile range, 62-75 years); 14 (17%) were female. All patients had class III/IV symptoms. Previous operations included multiple coronary artery bypass grafts (15 patients [18%]) and heart transplantation (1 patient [1%]). Internal thoracic artery graft from a previous operation was patent in 43 patients (51%). Perioperative hemodynamic support with inotropes (35%) and intra-aortic balloon pump (14%) or ventricular assist device (2%) was common. The surgical approach varied for each patient. One operative death (1%) occurred. Estimated survival at 5 and 7 years was 77% and 67%, respectively. Late major adverse cardiac events observed during follow-up were cardiac death (n=66), nonoperative reintervention (n=8), and nonfatal myocardial infarction (n=5). CONCLUSION: Off-pump coronary artery bypass grafting can mitigate reoperative risk in patients with an estimated risk of 10% or higher who are undergoing single- or double-vessel revascularization with satisfactory long-term outcome.     

心脏瓣膜置换后早期住院患者死亡因素分析

背景：积极加强对高危患者心脏瓣膜置换前、中和置换后的处理,可降低心脏瓣膜置换后早期死亡率。 目的：分析心脏瓣膜病患者置换治疗后早期住院死亡的危险因素,提高手术治愈率。方法：回顾分析488例心脏瓣膜病患者行手术治疗作为临床资料;以置换后早期住院死亡为研究终点,采用单素及多因素Logistic回归方法分析置换后早期死亡的危险因素。结果与结论：488例心脏瓣膜置换患者中,置换后早期死亡27例,总死亡率5.5%。主要的死亡原因是低心排综合征、恶性心律失常、多器官功能衰竭。单因素分析显示：年龄≥60岁、心功能IV级、联合瓣膜手术以及同期冠状动脉旁路移植、左室射血分数≤50%、左室舒张末内径≥70 mm、体外循环时间≥120 min、主动脉阻断时间≥ 60 min与心脏瓣膜后死亡的发生具有相关性（P 〈 0.05）。多因素Logistic回归分析结果：年龄≥ 60岁、心功能IV级、瓣膜手术同期冠状动脉旁路移植、体外循环时间≥120 min、左室射血分数≤50% 、左室舒张末内径≥70 mm是影响心瓣膜置换后早期死亡的独立危险因素。重视围手术期处理,针对这些因素合理把握手术指征、选择合适的手术方式以及心肌保护,可以进一步降低这类患者手术并发症和病死率。     

Increasing use of Medicare services by veterans with acute myocardial infarction.

OBJECTIVES: Some of the nation's 26 million veterans have two government-financed health care entitlements: Medicare and the Department of Veterans Affairs (VA). The aims of this investigation were to examine trends where Medicare-eligible VA users are initially hospitalized for acute myocardial infarction (AMI) and then to assess rates of cardiac procedure use and mortality for veterans initially admitted to each system of care. METHODS: We used VA and HCFA national databases to identify VA users (age range, > or = 65 years) who were initially admitted to a VAMC or Medicare financed hospital (Medicare hospital) with a primary diagnosis of AMI between January 1, 1992, and December 31, 1995, (n = 47,598). We examined the use of cardiac procedures (cardiac catheterization [CC], coronary artery bypass surgery [CABG], and coronary angioplasty [CA] and mortality (30-day and 1-year) by the type of initial admitting hospital within each system of care. RESULTS: Almost 70% of VA users hospitalized for AMI were initially admitted to Medicare hospitals versus VAMCs between 1992 (64%) and 1995 (72%). After adjusting for patient characteristics in logistic models, VA users initially hospitalized in Medicare hospitals were significantly more likely to undergo cardiac procedures than were VA users hospitalized in VAMCs. Differences in the odds of receiving a procedure were most significant when comparing Medicare hospitals with on-site cardiac technology to VA hospitals without on-site cardiac technology (CC: OR 4.34, 95% CI 3.98-4.73; CABG: OR 2.16, 95% CI 1.92-2.43; CA: OR 4.56, 95% CI 3.98-5.25). We found no significant differences in 30-day and 1-year adjusted mortality rates between VA users initially admitted to VAMCs or Medicare hospitals. CONCLUSIONS: Medicare-eligible VA users are increasingly hospitalized in Medicare hospitals for AMI. VA users cared for in Medicare hospitals receive more cardiac procedures but have the same survival as VA users cared for in VAMCs. These findings have policy implications for access, quality, and costs in both systems of care.     

婴幼儿体外循环的围手术期护理

目的 探讨婴幼儿体外循环的围手术期护理配合要点,以提高护理质量.方法 对137例婴幼儿体外循环心内直视手术的整体护理进行回顾性分析总结.结果 1例因术后引流多再次开胸止血,2例因术后低心排出量导致全身多器官功能衰竭死亡外,其余均治愈出院.无手术护理配合不当所致并发症发生.结论 充分的术前准备、熟练的术中配合、认真的护理操作的普片原则和个体化的护理方案是减少婴幼儿心脏直视手术并发症和病死率的重要保证.     

三种心肌标志物检测对心肌梗死及心力衰竭临床诊断的价值

目的探讨血清氨基末端B型钠尿肽原（NT-proBNP）、肌红蛋白（Myo）、心肌肌钙蛋白T（cTnT）对急性心肌梗死（AMI）及心力衰竭（HF）患者的临床诊断价值,研究3种标志物的特点,并根据其特点和患者病情选用合适的标志物。方法采用电化学发光免疫方法检测55例AMI患者治疗前、后以及105例HF患者、30名健康正常者的NT-proBNP、Myo、cTnT水平。按照美国纽约心脏病协会（NYHA）心功能分级标准将HF患者分为Ⅰ～Ⅳ级。比较各组的差异并作相关性分析,同时采用受试者工作特征（ROC）曲线评估3种标志物的灵敏度和特异性。结果 cTnT、Myo在AMI患者胸痛时间6 h内的诊断灵敏度分别为76.2%和93.9%,胸痛时间〉6 h时的诊断灵敏度分别为90.5%和55.6%,AMI患者治疗后NT-proBNP、Myo、cTnT水平明显低于治疗前（P〈0.05）。NYHAⅠ～Ⅳ级的HF患者间NT-proBNP、Myo、cTnT水平差异有统计学意义（P〈0.05）。HF患者NT-proBNP水平与NYHA分级的相关性（rs=0.884）高于Myo（rs=0.652）和cTnT（rs=0.726）。结论在心功能分级以及AMI早期预警和早期诊断方面,NT-proBNP的灵敏度及相关性要明显优于Myo和cTnT,还常用于在呼吸困难人群中鉴别HF患者。Myo常作为急诊中排除急性心肌梗死的指标,早期诊断时要结合患者胸痛时间,观察有无再梗死或梗死再扩展。cTnT诊断AMI的特异性优于其他标志物,但要等到心肌梗死后才能做出判断。     

婴幼儿体外循环的围手术期护理

目的探讨婴幼儿体外循环的围手术期护理配合要点,以提高护理质量。方法对137例婴幼儿体外循环心内直视手术的整体护理进行回顾性分析总结。结果1例因术后引流多再次开胸止血,2例因术后低心排出量导致全身多器官功能衰竭死亡外,其余均治愈出院。无手术护理配合不当所致并发症发生。结论充分的术前准备、熟练的术中配合、认真的护理操作的普片原则和个体化的护理方案是减少婴幼儿心脏直视手术并发症和病死率的重要保证。     

16例急性心肌梗死患者肌钙蛋白T的临床分析

目的：探讨肌钙蛋白T(cTnT)在急性心肌梗死(AMI)早期诊断中的作用。方法：前瞻性对比分析16例AMI患者与35例非AMI的cTnT与肌酸激酶同工酶(CK-MB)的变化。结果：cTnT在AMI患者的血中出现较早。与CK-MB比较，其对AMI的敏感性高、特异性强。结论：cTnT检测是较理想的早期诊断AMI方法之一，特别在基层医院。     

缺血预适应对急性心肌梗死合并糖尿病患者预后的影响

目的　探讨心肌缺血预适应对急性心肌梗死合并糖尿病患者临床状况及近期预后的影响。方法　 6 7例确诊为急性心肌梗死同时合并有糖尿病的患者 ,根据心肌梗死发病前 1周内有无心绞痛发作分为缺血预适应组 (2 8例 )和对照组 (39例 ) ,两组基础临床情况类似。观察心肌梗死范围、心肌酶学改变、左室射血分数及住院期间泵衰竭、心源性休克、严重心律失常等心脏事件的发生率和病死率。结果　缺血预适应组患者临床状况及近期预后较好 ,与对照组相比 ,梗死面积小 ,≥ 2个梗死面的检出率低 (32 .1%与 5 6 .4 % ,P <0 .0 5 ) ,血浆CPK、CK MB、cTnT峰值均显著降低 (P <0 .0 1或P <0 .0 5 ) ,且住院期间的泵衰竭发生率(17.9%与 4 1.0 % ,P <0 .0 5 )、心源性休克 (10 .7%与 33.3% ,P <0 .0 5 )、严重心律失常 (14 .3%与 4 6 .2 % ,P<0 .0 1)及住院病死率 (3.6 %与 2 0 .5 % ,P <0 .0 5 )均降低。结论　缺血预适应对急性心肌梗死合并糖尿病的患者有保护作用 ,可以减少心肌梗死面积 ,降低临床并发症的发生率 ,但不能改善左室射血分数与促进心功能的恢复