心脏停跳与不停跳先心病矫治术患者围术期cTnⅠ及心肌酶水平变化

目的探讨心脏停跳与不停跳先天性心脏病（先心病）矫治术对心肌的损伤程度，并寻找敏感性评价指标。方法将40例同期拟行先心病矫治术的患者随机分为对照组和观察组各20例，分别于心脏停跳与不停跳下手术，两组麻醉及体外循环（CPB）方法相同。分别于围术期检测血清心肌肌钙蛋白Ⅰ（cTnⅠ）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、AST、α-羟丁酸脱氢酶（HBDH），同时观察心电图及心脏超声指标改变。结果两组围术期心电图及心脏超声指标均无明显异常，但术中、术后血清cTnⅠ及CK、CK—MB、LDH水平均明显升高，对照组显著高于观察组；其中血清cTnⅠ水平升高出现早、恢复慢（术后72h时仍显著高于术前水平）。结论心脏不停跳先心病矫治术对心肌的损伤小于心脏停跳手术；cTnⅠ是评价心脏手术围术期心肌损伤敏感的特异指标．

Perioperative changes of cTnl and cardiac enzymes in patients undergoing cardiopulmonary bypass with beating and arrested heart

Objective To investigate the myocardial ischemie reperfusion injury during eardiopulmonary bypass with beating and arrested heart. Methods 40 cases wih congenital heart diseases （CHD）were divided into the observed group and the control group with 20 in each, then treated with cardiopulmonary bypass with beating and arrested heart. Perioperatire changes of cTnⅠ and cardiac enzymes were detected , the changes of electrocardiogram （ECG） and ultrasound measurement were observed. Results ECG and ultrasound measurementin beth groups were nearly normal, cTnI and cardiac enzymes in both grups increased significantly, especially in the control group.Among wieh , the rise of cTnl appeared earlier and resumed slower. Conclusions 331e myocardial ischemic reperfusion injury during cardiopulmonary bypass with beating is lighter than that with arrested heart, cTnⅠ can be used as sensitive and special indicators for evaluating ischemic injury.