肌钙蛋白T判断心脏手术心肌保护效果的临床应用

以心肌肌钙蛋白Ｔ（ｃＴｎＴ）、肌酸激酶（ＣＫ）等为指标，对浅低温心脏不停跳心内直视术（实验组）及低温心脏停跳术（对照组）的心肌保护效果进行了临床研究。发现：①ｃＴｎＴ于停机时，术后２４ｈ、４８ｈ、７２ｈ两组均升高，但各时间段实验组低于对照组；②ＣＫ酶于停机时两组无差异，术后２４ｈ、４８ｈ实验组低于对照组，术后７２ｈ两组均恢复正常；③开胸非心脏手术患者的ｃＴｎＴ值均为正常。结果提示，浅低温心脏不停跳术心肌保护效果优于低温心脏停跳者，其反映心肌损伤程度的指标ｃＴｎＴ的敏感性与特异性明显优于心肌酶谱。ｃＴｎＴ在心肌保护效果方面的研究具有广阔前景

Evaluation of Myocardial Protective Effect by Cardiac Troponin T Measurements during Heart Operation

The myocardial protective effect was clinically studied by determining the levels of cardiac troponin T (cTnT) and CK in group 1 (moderate hypothermia with unarrested heart without aorta cross claming) and group 2 (hypothermia with arrested heart during cardiopulmonary bypasss) The results indicated that :1) Immediate after cardiopulmonary bypass(CPB) and 24 h,48 h and 72 h after heart operation,cTnT level was increased in both groups,but was significantly lower in groups 1 than that in group 2 at each time point;2)The level of CK in both two groups after CPB had no significantly difference,but was significantly lower in group 1 than that in group 2 24,48 h after operation CK level in both groups returned to normal 72 h after operation;3)The level of cTnT in the patients undergoing lung surgery without heart operation was normal It was concluded that the myocardial protective effect under moderate hypothermia with unarrested heart was superior to that of hypothermia with arrested heart As indicators for reflecting the myocardial injury,the sensitivity and specificity of cTnT are more valuable than those of myocardial enzyme