摘要
目的 观察体外循环心脏手术相关因素致心肌细胞的损害程度 ,通过心肌肌钙蛋白T变化找出其相对规律及数据 ,为临床提供心肌保护措施及理论根据。 方法 随机选择 37例心脏手术 ,其中心脏瓣膜替换术 15例 ,先天性心脏病 15例 ,冠状动脉搭桥 7例 ,于手术前、停机时、术后 5h、术后第 1天、术后第 2天抽血检测肌钙蛋白T ,然后按主动脉阻断时间、心脏停跳液用量、停机时有否代谢性酸中毒及手术创伤等对肌钙蛋白T浓度的变化经统计学处理 ,q检验进行对比研究。 结果 (1)主动脉阻断时间 >6 0min组术后 5小时肌钙蛋白T明显高于阻断 <30min组 ,P <0 0 1。 (2 )心脏停跳液用量 <10ml/kg组与 >15ml/kg组相比有差异性P <0 0 5。 (3)术中有代谢性酸中毒组较正常组相比有显著性差异P <0 0 1。 (4)严重手术创伤组与普通组相比在停机时差异有极显著性意义(P <0 0 1)。 结论 手术创伤是心肌细胞损害的最主要因素 ,主动脉阻断时间过长 ,停跳液用量不足 ,术中有代谢性酸中毒也是心肌损害的重要因素。肌钙蛋白T是心肌损害反应敏感性及特异性较高的酶 ,心脏手术中检测此酶可为临床心肌保护提供客观依据。
Objective[WT5”BZ] To elvaluate the effect of cardiopulmonary bypass (CPB) on myocaridial troponin T and its clinical significance and relationship to myocadial cell injury. [WT5”HZ]Methods[WT5”BZ] Thirty seven patients underwent open heart surgery under CPB. The procedures included correction of congenital heart disease in 15 patients, valve replacement in 15, and coronary artery bypass grafting in 7. Blood samples were taken at four different time intervals for assessin a troponin T. Correlative factors including duration of clamping of aorta, dosage of cardioplegic solution, and metablic acidosis were studied. [WT5”HZ]Results[WT5”BZ] When clamping time >60 minutes, dosage of cardioplegia solution <10 ml/kg and exsiting metabolic acidosis, the level of troponin T was significantly increased ( P <0 01). [WT5”HZ]Conclusion[WT5”BZ] The elevation of troponin T is closely related to cardiopulmonary bypass, especially the duration of clamping of aorta, insufficiency of cardiolegia, and metabolic acidosis. [WT5”HZ]
出处
《中华外科杂志》
CAS
CSCD
北大核心
2000年第5期372-374,共3页
Chinese Journal of Surgery
