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目的观察婴儿先天性心脏病(先心病)围手术期心肌肌钙蛋白I(cardiactroponinI,cTnI)水平的动态变化,探讨其对围手术期心肌损伤的诊断价值。方法分别于术前24h、术后24h、72h及术后7日取因先心病行心内直视手术婴儿的外周血检测cTnI、肌酸激酶、CK-MB、乳酸脱氢酶(lacticdehydrogenase,LDH),并将术后结果与术前进行对比分析。结果30例治愈出院,2例死亡。活存病例在术后24h、72h及术后7日的cTnI浓度均高于术前;肌酸激酶、CK-MB、LDH只分别在术后24h、72h与术前比较差异有统计学意义,术后7日与术前比较差异无统计学意义。在评价心肌损伤的敏感度方面,术后各时点cTnI均优于CK-MB(P<0.05)。术后7日心功能分级为Ⅲ～Ⅳ级与Ⅰ～Ⅱ级患儿的cTnI水平比较差异有统计学意义(P<0.05)。结论血清cTnI水平可反映婴儿先心病围手术期心肌损伤程度,并可作为预测患儿预后的指标。cTnI对评价心肌损伤具有较高的敏感度,其敏感度优于CK-MB,且诊断时间窗较CK-MB宽。
Objective To observe the dynamic changes of perioperative cardiac troponin I (cTnI) level in congenital heart disease (CHD) of infants and to evaluate the value of perioperative myocardial damage. Methods The levels of cTnI, creatine kinase, CK-MB and lactic dehydrogenase (LDH) were measured in peripheral blood of patients undergoing open heart surgery 24 hours before operation, 24 hours after operation, 72 hours after operation and 7 days after operation respectively. ), And postoperative results compared with preoperative analysis. Results 30 cases were cured and 2 patients died. The cTnI concentrations of surviving cases were higher than preoperative at 24h, 72h and 7th postoperatively. Creatine kinase, CK-MB and LDH were only significantly different at 24 h and 72 h after operation, respectively, There was no significant difference between preoperative and postoperative 7th. In evaluating the sensitivity of myocardial injury, cTnI was superior to CK-MB at all time points (P <0.05). The level of cTnI in grade Ⅲ ~ Ⅳ and grade Ⅰ ~ Ⅱ children after operation on the 7th was significantly different (P <0.05). Conclusions The level of serum cTnI can reflect the degree of perioperative myocardial injury in children with CHD and can be used as an index to predict the prognosis of children. cTnI for the evaluation of myocardial injury has a higher sensitivity, its sensitivity is superior to CK-MB, and diagnostic time window wider than CK-MB.