心脏瓣膜置换病人围术期心肌损伤的早期诊断

目的　比较血浆心肌型脂肪酸结合蛋白 (H -FABP)和CK -MB快速敏感反映心脏瓣膜置换术中心肌损伤的能力 ,评估H -FABP和CK -MB心脏瓣膜置换病人围术期心肌损害的诊断效率。方法　 14例择期行瓣膜置换手术病人 ,分别在中心静脉开放后 (T1) ,体外循环前即刻 (T2 ) ,主动脉开放即刻 (T3) ,主动脉开放 1h(T4 ) ,主动脉开放 2h(T5)主动脉开放 3h(T6 ) ,主动脉开放 18h(T7) ,抽取中心静脉血测定血清中H -FABP和CK -MB。结果　H -FABP值在体外循环前即明显升高 ,主动脉开放即刻升高数 10倍 ,阳性率达10 0 % ,主动脉开放 1h达到高峰 ,主动脉开放 3h明显下降 (P <0 0 5 ) ,主动脉开放 18h降到体外循环前水平。CK -MB升高的时间迟于H -FABP ,仅在主动脉开放时才有明显变化 ,阳性率 78 6 % ,主动脉开放 1h阳性率 10 0 % ,主动脉开放 18h阳性率 78 6 %。结论　H -FABP与CK -MB相比具有变化早恢复快的特点 ,有早期诊断价值 ,对于心肌损伤的及时变化有特异性

Early Diagnosis of Heart Injury at Perioperation Stage for Valve Replacement Patients

Objective To compare the changes of H-FABP and CK-MB that reflect rapidly the myocardia injury in perioperation of valve replacement and assess the diagnostic rate of H-FABP and CK-MB. Methods The H-FABP and CK-MB of 14 cases of valve replacement patient were detected at varied time perioperatively. Results The positive rate of H-FABP was 100% that elevated before CPB and aorta openning and it reached peak at 1 h. It reduced at 3 h at aorta openning and decreased the level as before CPB (P<0.05). The positive rate of CK-Mb was 78.6% at aorta opening and increased at 1 h to 100%, then reduced at 18 h at 78.6%. Conclusion The H-FABP might have characters of early changes and recovered compared with CK-MB so that it should have early diagnostic value for the myocardiac injury with specificity.