心脏标志物对体外循环和主动脉交叉阻断下冠状动脉旁路移植术的反应。

Cardiac marker responses to coronary artery bypass graft surgery with cardiopulmonary bypass and aortic cross-clamping.

作者信息

Takeda Shinhiro, Nakanishi Kazuhiro, Ikezaki Hiroyuki, Kim Chol, Sakamoto Atsuhiro, Tanaka Keiji, Ogawa Ryo

机构信息

Department of Anesthesiology and Intensive Care Medicine, Nippon Medical School, Tokyo, Japan.

出版信息

J Cardiothorac Vasc Anesth. 2002 Aug;16(4):421-5. doi: 10.1053/jcan.2002.125150.

DOI:10.1053/jcan.2002.125150

PMID:12154418

Abstract

OBJECTIVE

To study several markers of myocardial injury in relation to aortic cross-clamping and cardiopulmonary bypass (CPB) after coronary artery bypass graft (CABG) surgery.

DESIGN

Prospective observational study.

SETTING

University hospital.

PARTICIPANTS

Thirty adult patients who underwent elective CABG surgery with aortic cross-clamping and CPB.

MEASUREMENTS AND MAIN RESULTS

Serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8), troponin-T (TnT), myosin light chain I (MLCI), and MB isoenzyme of creatine kinase (CK-MB), as markers of myocardial injury, were measured after induction of anesthesia for baseline values, then again at the end of surgery and on postoperative days 1, 3, and 5. IL-6, IL-8, and CK-MB levels were significantly elevated in the early postoperative stage. TnT significantly increased from the end of surgery to postoperative day 5. MLCI increased also but later than TnT. Aortic cross-clamping time correlated positively with peak TnT (r = 0.51, p < 0.05), TnT level on postoperative day 1 (r = 0.69, p < 0.01), and MLCI level on postoperative day 5 (r = 0.45, p < 0.05). CPB time was correlated only with peak TnT (r = 0.47, p < 0.05).

CONCLUSIONS

The increase in TnT level is strongly related to aortic cross-clamping.

摘要

目的

研究冠状动脉旁路移植术（CABG）后与主动脉交叉阻断及体外循环（CPB）相关的几种心肌损伤标志物。

设计

前瞻性观察研究。

地点

大学医院。

参与者

30例接受择期CABG手术并进行主动脉交叉阻断及CPB的成年患者。

测量指标及主要结果

在麻醉诱导后测量血清白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肌钙蛋白T（TnT）、肌球蛋白轻链I（MLCI）和肌酸激酶MB同工酶（CK-MB）水平作为心肌损伤标志物的基线值，然后在手术结束时以及术后第1、3和5天再次测量。术后早期IL-6、IL-8和CK-MB水平显著升高。TnT从手术结束到术后第5天显著增加。MLCI也增加，但比TnT晚。主动脉交叉阻断时间与TnT峰值（r = 0.51，p < 0.05）、术后第1天的TnT水平（r = 0.69，p < 0.01）和术后第5天的MLCI水平（r = 0.45，p < 0.05）呈正相关。CPB时间仅与TnT峰值相关（r = 0.47，p < 0.05）。