非停跳冠状动脉旁路移植术围手术期肌钙蛋白I、肌酸激酶同工酶及肌红蛋白变化的研究

目的观察非停跳冠状动脉旁路移植术围手术期肌钙蛋白（IcTnI）、肌酸激酶同工酶（CK-MB）及肌红蛋白（Myo）的动态变化情况。方法检测30例非停跳冠状动脉旁路移植术患者术前、术中、术后即刻、术后3 h、6 h、12 h、24 h、48 h、72 hcTnI、CK-MB及Myo的浓度变化。结果患者术前各项指标均在正常参考值范围,cTnI术后6 h明显升高（与术前比较P〈0.05）,于术后24 h达高峰;CK-MB于关胸即刻明显升高（与术前比较P〈0.05）,术后6 h达高峰;Myo术中明显升高（与术前比较P〈0.05）,于关胸即刻达高峰。结论非停跳冠状动脉旁路移植术可引起可逆性心肌损伤,应根据实际情况加强心肌保护,cTnI及CK-MB均于术后24 h达高峰,可应用于监测心肌细胞损伤程度。

Change of cardiac troponin I、CK-MB and Myo release in patients undergoing coronary artery bypass graft on a beating heart

Objective To investigate the change of cardiac troponin I、CK-MB and Myo in patients undergoing perioperation of coronary artery bypass graft on a beating heart.Methods Plasma cTnI,CK-MB and Myo were measured before operation,during the operation,immediately after operation and 3h,6h,12h,24h,48h,72h after operation in thirty patients undergoing coronary artery bypass graft on a beating heart.Results All variables were within normal range before operation,cTnI increased significantly at 6h after operation（P0.05）,and reached peak at 24h after operation;CK-MB increased significantly immediately after operation（P0.05）,and reached peak at 6h after operation;Myo increased significantly during operation（P0.05）,and reached peak immediately after operation.Conclusion Reversible myocardial injury may occur in patients undergoing coronary artery bypass graft on a beating heart,we should take myocardial preservation on the basis of actual condition,cTnI and CK-MB reach peak within 24h after operation,and are sensitive markers for monitoring degree of myocardial injury.