停跳与非停跳冠脉搭桥术后心肌肌钙蛋白水平的变化及其临床意义探讨

目的 研究停跳与非停跳冠脉搭桥术后心肌肌钙蛋白水平的变化。方法 30例择期行冠脉搭桥术的患者根据手术方式分为不停跳组(n=15)和停跳组(n=15)。不停跳组采用Octopus组织固定器局部固定心肌后进行冠脉搭桥，而停跳组在体外循环心脏停跳下进行冠脉搭桥。分别于入手术室(T0)、麻醉诱导平稳后(T1)、手术结束即刻(TST)、术后4h(T4)、8h(T8)、12h(T12)、24h(T24)、36h(T36)、48h(T48)抽静脉血4ml测定心肌肌钙蛋白T(cTnT)和心肌肌钙蛋白Ⅰ(cTnI)。结果 两组患者T0和Tl时cTnT、cTnI正常，术后则显著性升高。两组之间，组2比组l术后各时间点cTnT和cTnI升高均有显著性差异。两组cTnT于术后8小时达到峰值，并一直保持较高水平；cTnI于术后12小时达高峰，不停跳组cTnI在术后36小时即恢复正常水平。结论 不停跳搭桥比体外循环搭桥手术对心肌细胞损伤轻，持续时间短。心肌损伤时，cTnT比cTnI峰值出现早，持续时间长，似乎更加灵敏。

Changes of Cardiac Troponin after On- pump and Off- pump Coronary Artery Bypass Grafting

Objectives To study the changes of cardiac troponin after on-pump and off-pump coronary artery bypass grafting. Materials and Methods Thirty patients,scheduled for CABG,were divided into two groups. One is on-pump CABG,another is off-pump CABG. Serum cTnT and cTnI were measured before anesthesia,after anesthetic induction,immediately after operation and 4h,8h,12h,24h,36h,48h after operation. Results The value of cTnT and cTnI was all in normal range at T 0 as well as T I,and increased significantly after operation. The degree of elevation on cTnT and cTnI was significantly higher in group 2 than in group l. The peak value of cTnT was in 8h after operation whereas that of cTnI was in 12h after operation. The value of cTnI in group l after decreased to normal range 36h after operation. Conclusions The extent of myocardial injury is lower in off-pump CABG than in on-pump CABG. cTnT seems to be more sensitive than cTnI because of the peak value of cTnT appearing earlier.