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冠状动脉搭桥手术后使用心电图变化和心肌肌钙蛋白I进行围手术期心肌梗死诊断

Perioperative myocardial infarction diagnosis after coronary artery bypass grafting surgery using coupled electrocardiographic changes and cardiac troponin I.

作者信息

Shahzamani Arvin, Sheikhbahaei Erfan, Shahabi Shahab, Shahzamani Mehran, Hemasian Helia, Hadi Niayesh, Zamani Sara

机构信息

School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Cardiovascular Research Institute, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Indian J Thorac Cardiovasc Surg. 2019 Jan;35(1):25-30. doi: 10.1007/s12055-018-0713-4. Epub 2018 Aug 28.

Abstract

PURPOSE

Perioperative myocardial infarction (PMI) is one of the most common causes of prolonged intensive care unit (ICU) and hospital stay after coronary artery bypass grafting (CABG) and is associated with poor prognosis and increases postoperative mortality due to the lack of accurate diagnostic methods. This study examines the association between electrocardiography (ECG) ischemic changes and cardiac troponin I concentration.

METHODS

In this cross-sectional study, the ECG of 100 patients was recorded before and 24 h after the surgery. The cardiac troponin I concentration was measured 24 h after the termination of the surgery.

RESULTS

The average concentration of troponin I was 6.79 μg/L in the no-ECG-changes group, 11.69 μg/L in the ST depression group, 11.26 μg/L in the ST elevation group, and 27.54 μg/L in the new Q wave group. The mean troponin concentration was significantly higher in the ECG-changes group compared to no-ECG-changes group. Comparing the ECG-changes together showed significant differences between the new Q wave and the other changes. ST elevation and ST depression were not statistically significant.

CONCLUSION

The three ECG-changes groups had a higher risk of PMI after their CABG. The risk of PMI was at its highest value in the new Q wave group and at its lowest in the no-ECG-changes group.

摘要

目的

围手术期心肌梗死(PMI)是冠状动脉旁路移植术(CABG)后重症监护病房(ICU)延长住院时间和住院时间延长的最常见原因之一,由于缺乏准确的诊断方法,其与预后不良相关,并增加术后死亡率。本研究探讨心电图(ECG)缺血性改变与心肌肌钙蛋白I浓度之间的关系。

方法

在这项横断面研究中,记录了100例患者手术前和术后24小时的心电图。在手术结束后24小时测量心肌肌钙蛋白I浓度。

结果

无心电图改变组肌钙蛋白I的平均浓度为6.79μg/L,ST段压低组为11.69μg/L,ST段抬高组为11.26μg/L,新Q波组为27.54μg/L。与无心电图改变组相比,心电图改变组的平均肌钙蛋白浓度显著更高。将心电图改变进行比较显示,新Q波与其他改变之间存在显著差异。ST段抬高和ST段压低无统计学意义。

结论

这三组心电图改变的患者在CABG术后发生PMI的风险较高。PMI风险在新Q波组最高,在无心电图改变组最低。

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Acute Myocardial Infarction.急性心肌梗死
N Engl J Med. 2017 May 25;376(21):2053-2064. doi: 10.1056/NEJMra1606915.

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