Hirsch R, Dent C L, Wood M K, Huddleston C B, Mendeloff E N, Balzer D T, Landt Y, Parvin C A, Landt M, Ladenson J H, Canter C E
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
Ann Thorac Surg. 1998 May;65(5):1394-9. doi: 10.1016/s0003-4975(98)00228-8.
Perioperative myocardial injury is a major determinant of postoperative cardiac dysfunction for congenital heart disease, but its assessment during this period is difficult. The objective of this study was to determine the suitability of using postoperative serum concentrations of cardiac troponin I (cTnI) for this purpose.
Cardiac troponin I levels were measured serially in the serum of patients undergoing uncomplicated repairs of atrial septal defect (n = 23), ventricular septal defect (n = 16) or tetralogy of Fallot (n = 16). The concentrations were correlated with intraoperative parameters (cardiopulmonary bypass time, aortic cross-clamp time, and cardiac bypass temperature), and postoperative parameters (magnitude of inotropic support, duration of intubation, and postoperative intensive care and hospital stay).
Postoperative absolute cTnI levels were lesion specific, with a pattern of increase and decrease similar for each lesion. For the total cohort, significant correlations between postoperative cTnI levels at all times (r = 0.43 to 0.83, p < 0.05) until 72 hours were noted for all parameters, except for cardiac bypass temperature. When evaluated as individual procedure groups, no significant relationships were noted in the atrial septal defect group, whereas postoperative cTnI levels were more strongly correlated with all intraoperative and postoperative parameters in the ventricular septal defect group than in the tetralogy of Fallot group.
This study suggests that cTnI values immediately after operation reflect the extent of myocardial damage from both incisional injury and intraoperative factors. Cardiac tropinin I levels in the first hours after operation for congenital heart disease are a potentially useful prognostic indicator for difficulty of recovery.
围手术期心肌损伤是先天性心脏病术后心脏功能障碍的主要决定因素，但在此期间对其进行评估较为困难。本研究的目的是确定术后血清心肌肌钙蛋白I（cTnI）浓度用于此目的的适用性。
对接受房间隔缺损（n = 23）、室间隔缺损（n = 16）或法洛四联症（n = 16）单纯修补术的患者血清进行连续心肌肌钙蛋白I水平测定。这些浓度与术中参数（体外循环时间、主动脉阻断时间和心脏搭桥温度）以及术后参数（正性肌力支持强度、插管持续时间、术后重症监护和住院时间）相关。
术后绝对cTnI水平具有病变特异性，每种病变的升高和降低模式相似。对于整个队列，除心脏搭桥温度外，所有参数在术后72小时内的cTnI水平与所有时间点均存在显著相关性（r = 0.43至0.83，p < 0.05）。当作为个体手术组进行评估时，房间隔缺损组未发现显著相关性，而室间隔缺损组术后cTnI水平与所有术中及术后参数的相关性比法洛四联症组更强。
本研究表明，术后即刻的cTnI值反映了切口损伤和术中因素导致的心肌损伤程度。先天性心脏病术后最初几小时的心肌肌钙蛋白I水平是恢复困难程度的潜在有用预后指标。
