Langenbach M R, Korbmacher B, Schulte H, Zirngibl H, Grabensee B, Plum J
Klinikum Barmen Abteilung für Viszeral- und Allgemeinchirurgie Heusnerstr. 40 42283 Wuppertal.
Z Kardiol. 2000 Dec;89(12):1133-40. doi: 10.1007/s003920070141.
Plasma levels of ANP (pg/ml; radioimmunoassay) as a parameter for postischemic dysfunction and levels of Troponin T (TnT) (ng/ml; ELISA test) as a parameter for postischemic cellular damage were determined in 15 patients with coronary artery disease (CAD) (mean age: 58 +/- 6.1 years; 13 m, 2 w; with no history of myocardial infarction and no signs for congestive heart failure) prior to, during and after extracorporal circulation (ECC). Under standardized conditions during the ECC basic parameters concerning the cardial hemodynamic (heart rate (HR); systolic (RRsys, mmHg), diastolic pressure (RR dia, mmHg) central venous pressure (CVP, mmHg); left atrial pressure (LAP, mmHg); left ventricular enddiastolic pressure (LVEDP, mmHg)) and ECG monitoring blood samples were performed: 1) prior to operation (op); 2) prior to CPB; 3) 1 h CPB; 4) 5 min after CPB; 5) 1 h after CPB; 6) 6 h postoperative (postop); 7) 24 h postop; 8) 48 h postop; 9) 10 days postop. Also the left atrial diameter (LAD, mm) and the left ventricular enddiastolic diameter at Q (LVEDD, mm) pre- and postop were documented with m-mode echocardiography (Echo) and ejection fraction (EF, %) was calculated. The bypass operations were performed with intermittent aortic cross-clamping with open venae cavae (CVP: 0-5 mmHg) and moderate hypothermia. For the determination of ANP levels and TnT levels in arterial and venous blood, a double-antibody (AB) radioimmunoassay and an ELISA test were used. Concerning the patients with CAD there was a maximal increase of ANP from preoperative 90 +/- 10 (M +/- SEM) pg/ml (p < 0.05) up to intraoperative 380 +/- 38 pg/ml. Ten days postop, the ANP level was with 262 +/- 33 pg/ml still increased threefold in comparison to the preoperative level. TnT showed an increase from preoperative 0.02 +/- 0.01 ng/ml up to intraoperative 3.44 +/- 0.47 ng/ml. Ten days postop the TnT concentration was at the preoperative level with 0.13 +/- 0.11 ng/ml. Five minutes after bypass up to 48 h postop, ANP and TnT levels were correlated (p < 0.05, r = 3.4). There was an increase of the LAD from preoperative 42.2 +/- 1.1 mm up to 46.8 +/- 1.2 mm (p < 0.05) 10 days postop as determined by m-mode echo. LVEDD and EF changed from preoperative 51.1 +/- 0.9 mm and 73 +/- 2% to 54.5 +/- 1.2 mm and 65 +/- 4% 10 days postop. The significant increase of TnT (172-fold) indicates the cellular, myocardial injury, caused by the operation without signs in ECG recordings and no signs of congestive heart failure. The significantly increased ANP level up to the 10th day postop indicate sa very sensitive prolonged, postischemic dysfunction, which is not compensated 10 days postop.
在15例冠状动脉疾病（CAD）患者（平均年龄：58±6.1岁；13例男性，2例女性；无心肌梗死病史且无充血性心力衰竭体征）体外循环（ECC）前、中、后，测定血浆心钠素（ANP）水平（pg/ml；放射免疫测定法）作为缺血后功能障碍的参数，以及肌钙蛋白T（TnT）水平（ng/ml；酶联免疫吸附测定法）作为缺血后细胞损伤的参数。在ECC期间的标准化条件下，记录有关心脏血流动力学的基本参数（心率（HR）；收缩压（RRsys，mmHg）、舒张压（RR dia，mmHg）、中心静脉压（CVP，mmHg）；左心房压（LAP，mmHg）；左心室舒张末期压力（LVEDP，mmHg））并进行心电图监测，采集血样：1）手术前（op）；2）体外循环前；3）体外循环1小时；4）体外循环后5分钟；5）体外循环后1小时；6）术后6小时（postop）；7）术后24小时；8）术后48小时；9）术后10天。还通过M型超声心动图（Echo）记录术前和术后的左心房直径（LAD，mm）和Q点处的左心室舒张末期直径（LVEDD，mm），并计算射血分数（EF，%）。旁路手术采用间歇性主动脉交叉钳夹，开放腔静脉（CVP：0 - 5 mmHg）并进行中度低温。采用双抗体（AB）放射免疫测定法和酶联免疫吸附测定法测定动脉血和静脉血中的ANP水平和TnT水平。对于CAD患者，ANP从术前的90±10（M±SEM）pg/ml（p<0.05）最大增至术中的380±38 pg/ml。术后10天，ANP水平为262±33 pg/ml，仍比术前水平增加了两倍。TnT从术前的0.02±0.01 ng/ml增至术中的3.44±0.47 ng/ml。术后10天，TnT浓度为0.13±0.11 ng/ml，恢复到术前水平。体外循环后5分钟至术后48小时，ANP和TnT水平呈正相关（p<0.05，r = 3.4）。通过M型超声心动图测定，术后10天LAD从术前的42.2±1.1 mm增至46.8±1.2 mm（p<0.05）。术后10天，LVEDD和EF分别从术前的51.1±0.9 mm和73±2%变为54.5±1.2 mm和65±4%。TnT显著升高（172倍）表明手术引起了细胞性心肌损伤，心电图记录无异常且无充血性心力衰竭体征。术后第10天ANP水平显著升高表明存在非常敏感的、持续时间长的缺血后功能障碍，术后10天仍未得到代偿。
