Caputo M, Dihmis W, Birdi I, Reeves B, Suleiman M S, Angelini G D, Bryan A J
Bristol Heart Institute, Bristol Royal Infirmary, UK.
Eur J Cardiothorac Surg. 1997 Aug;12(2):254-60. doi: 10.1016/s1010-7940(97)00102-4.
To evaluate and compare myocardial protection using cold crystalloid and blood cardioplegia by measuring release of cardiac Troponin T and Troponin I during coronary artery surgery.
Forty two patients undergoing myocardial revascularization were prospectively randomised into two groups in whom myocardial protection was achieved with either antegrade cold (4 degrees C) crystalloid (CCP) (n = 21) St. Thomas' I cardioplegic solution. Serial venous blood samples were collected for measurement of cardiac Troponin T and Troponin I, prior to induction of anesthesia and at 4, 12, 24 and 48 h after removal of the aortic cross clamp.
There were no hospital deaths in the two groups and one patient in each group suffered a perioperative myocardial infarction. Rising levels of Troponin T and Troponin I were found in all patients. Serum concentrations increased as early as 4 h after removal of the aortic cross clamp, and reached a peak at 12 h postoperatively in both groups. These levels subsequently declined, but remained higher than preoperative values at 48 h. There were no differences between the two groups with respect to serum Troponin T and I release at 4, 12, 24 and 48 h, area under the respective curves, and peak Troponin T and I release. Serum Troponin levels were significantly higher in patients with unstable angina and in two patients who suffered a perioperative myocardial infarction.
Serum release of cardiac Troponin T and Troponin I is significantly raised in low risk patients undergoing myocardial revascularization. This release is similar when either cold crystalloid or cold blood cardioplegia are used. This may imply that both methods offer identical protection to the myocardium in a low risk group of patients.
通过测量冠状动脉手术期间心肌肌钙蛋白T和肌钙蛋白I的释放，评估和比较冷晶体停搏液与冷血停搏液对心肌的保护作用。
42例接受心肌血运重建的患者被前瞻性随机分为两组，分别采用顺行性冷（4℃）晶体停搏液（CCP）（n = 21）和圣托马斯I号心脏停搏液进行心肌保护。在麻醉诱导前以及主动脉阻断钳移除后4、12、24和48小时采集系列静脉血样本，用于测量心肌肌钙蛋白T和肌钙蛋白I。
两组均无院内死亡病例，每组各有1例患者发生围手术期心肌梗死。所有患者的肌钙蛋白T和肌钙蛋白I水平均升高。血清浓度在主动脉阻断钳移除后4小时即开始升高，两组均在术后12小时达到峰值。随后这些水平下降，但在48小时时仍高于术前值。两组在4、12、24和48小时的血清肌钙蛋白T和I释放量、各自曲线下面积以及肌钙蛋白T和I释放峰值方面均无差异。不稳定型心绞痛患者以及2例发生围手术期心肌梗死的患者血清肌钙蛋白水平显著更高。
接受心肌血运重建的低风险患者血清中心肌肌钙蛋白T和肌钙蛋白I的释放显著升高。使用冷晶体停搏液或冷血停搏液时，这种释放情况相似。这可能意味着在低风险患者群体中，两种方法对心肌提供的保护相同。
