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非体外循环冠状动脉旁路移植术围术期cTnI,CK及CK-MB的变化(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2004年第3期
页码:
228-231
栏目:
临床研究
出版日期:
2004-05-01

文章信息/Info

Title:
Changes of troponin I，creatine kinase and creatine kinase-MB activities in serum during off-pump coronary artery bypass grafting
作者:
袁莉; 王世端; 江岩; 李筱琴
青岛大学医学院附属医院麻醉科，山东 青岛 266003
Author(s):
YUAN Li; WANG Shi-dean; JIANG Yan; LI Xiao-qin
Department of Anesthesiology，Affiliated Hospital of Qingdao University Medical College，Qingdao，Shandong 266003，China
关键词:
非体外循环冠状动脉旁路移植术; 心脏肌钙蛋白I; 心肌再灌注损伤; 肌酸磷酸肌酸; 肌酸磷酸激酶同工酶
Keywords:
coronary artery bypass; cardiac troponin I; myocardial reperfusion injury; creatine kinase; creatine kinase-MB
分类号:
R542. 2
DOI:
-
文献标识码:
A
摘要:
目的:通过对非体外循环冠状动脉旁路移植术(OPCABG)患者，围手术期血清心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶MB(CK-MB)变化的观察，探讨OPCABG围手术期心肌损伤的情况.方法:选择20例全麻常温下进行OPCABG患者及20例同期行肺叶切除术患者(对照组)，麻醉诱导气管插管后以微量输液泵持续输注异丙酚、利多卡因复合液，并间断静脉注射芬太尼和呱库澳按维持麻醉。在麻醉诱导前、术后1 h,24 h,48 h 4 个时间点抽取血样测定cTnI,CK ,C K-MB值。结果:所有患者手术经过及术后恢复顺利，OPCABG组无一例转为体外循环。两组患者术前CK,CK-MB均在正常范围，术后1h开始升高，术后24 h达峰值，与麻醉前比较，均P<0 .01 ;术后48h 明显下降，但仍高于麻醉前水平(P<0.01).4 个时间点两组CK,CK-MB值相比，差异无显著性。OPCABG组cTnl值与术前比较，术后1h开始升高(P<0.01),24h达峰值(P<0.01 )，术后48h 有所下降，但仍高于麻醉前水平(P<0.01 );而肺叶切除组术后cTnI值始终不高。术前、术后1h两组。TnI值差异无显著性，但OPCABG组术后24h ,48h 值均明显高于肺叶切除组(P<0.0 1)。手术全程及术后48h 动态心电图未发现心肌梗死，血流动力学比较平稳。结论:与肺叶切除组相比，OPCABG术后仍有心肌损伤存在。如何减轻其围手术期心肌损伤，有待进一步研究。
Abstract:
AIM:To investigate the changes of cardiac troponin I (cTnI)，creatine kinase (CK) and creatine kinase-MB (CK-MB) activities in serum during off-pump coronary artery bypass grafting (OPCABG). METHODS:Twenty ASA I-III patients undergoing OPCABG were in Group I.Twenty ASA I-III patients undergoing pulmonary lobectomy were chosen to heath control (Group I).Left radial artery was cannulated for intra-arterial pressure monitoring before anesthesia. Right internal jugular vein was cannulated for fluid administration and CVP monitoring. Anesthesia was induced with midazolam 0.05-0.1 mg·kg-1，fentanyl 5 -10μg·kg-1，arduan 0.12 mg·kg-1，lidocaine 1-2mg·kg-1 and maintained with propofol and lidocaine intravenous infusion at a rate of 3-5 mg·kg-1·h-1，supplemented with intermit intravenous boluses of fentanyl and arduan. After tracheal intubation，the patients were mechanically ventilated with 100% oxygen and PETCO2,was maintainedat 30 mmHg.Serum samplesw erec ollectedf or estimation of CK，CK-MB and cTnI activities at preoperative，1 hour, 24 hours，48 hours postoperative. RESULTS: CK，CK-MB activities at 1 hour，24 hours，48 hours postoperative in two groups were significantly higher than preoperative (P<0. 01).But there were no difference in the same time between two groups. CTnI activities at 1 hour，24 hours，48 hours postoperative were significantly higher than preoperative in Group I (P<0. 01)，but cTnI activities in Group 2 were in normal activities. There were no signs of myocardial infarction in electrocardiogram during the procedure and at 2 days postoperative in two groups. All patients recovered uneventfully. CONCLUSION: There are myocardial injury in OPCABG, how to alleviate its injury during OPCABG is still a work.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2003-6-9
更新日期/Last Update: 2004-05-01