婴幼儿先天性心脏病围术期hs-CRP和cTnI监测的临床意义

摘要

目的 探讨婴幼儿先天性心脏病(先心病)心内直视手术围术期,动态监测高敏C反应蛋白(hs-CRP)及血清心肌肌钙蛋白I(cTnI)水平的临床意义.方法 纳入2012年1月～2012年6月行心内直视手术30例,分为单纯型先天性心脏病组(n=10)、复合型先心病组(n=10)及复杂型先心病组(n=10).三组患儿均在体外循环支持下行先心病纠治术,分别于术前1h(T1)、术后1h(T2)、术后6h(T3)、术后24h(T4)、术后72h(T5)及术后7天(T6)检测其血清hs-CRP 及血清cTnI水平.同时纳入主动脉阻断时间、正性肌力药物评分、机械通气时间、重症监护病房(CICU)停留时间及术后住院时间与各时间点hs-CRP和cTnI水平进行相关性分析.结果 三组患儿T1 hs-CRP均在低度风险范围内,cTnI均在正常范围.术后hs-CRP及cTnI均较术前增高,尤以复杂型先心病组升高最为显著;cTnI水平与机械通气时间呈明显正相关(r=0.5297,P＜0.05),hs-CRP水平与CICU停留时间呈正相关(r=0.4242,P＜0.05).结论 监测hs-CRP和cTnI的水平能反映婴幼儿先心病(CPB)术后炎症反应的水平及心肌细胞的损害程度,对婴幼儿先心病体外循环转流(CPB)术后恢复期监测、评估及监护治疗具有指导意义.%Objective To investigate the clinical significance of dynamical monitoring the levels of high-sensitivity C—reactive protein ( hs—CRP ) and cardiac troponin T ( cTnT ) in infant with congenital heart diseasern( CHD ) during perioperation of cardiopulmonary bypass ( CPB ) operation. Methods The cases ( n =30 ) with CPB operation from Jan. 2012 to June, 2012 were divided into simple CHD group, compound CHD group and complex CHD group ( each n=10 ) . All groups were given rectification operation of CHD under CPB support. The levels of serum hs-CRP and cTnl were detected respectively 1 h ( Tl ) before operation, and 1 h ( T2 ) , 6 h (T3 ) , 24 h ( T4 ) , 72 h ( T5 ) and 7 days (T6 ) after the operation. At the same time aortic cross—clamp time, scores of positive inotropic drugs, time of mechanical ventilation, CICU duration and hospitalization time after operation were recorded and analyzed. Results The detecting result of hs—CRP was in low risk range and that of cTnl was in normal range in 3 groups 1 h before operation. After operation, the levels of hs—CRP and cTnl increased, which was the most significant in complex CHD group. The level of cTnl was significantly correlated to aortic cross—clamp time ( r=0.78, P<0.05 ) and time of mechanical ventilation ( r=0.63, P<0.05 ) respectively. The level of hs-CRP was significantly correlated to CICU duration ( r=0.67, P<0.05 ) . Conclusion The levels of hs—CRP and cTnl can reflect the level of inflammatory reaction and damage degree of myocardial cells in CHD infants after CPB operation. It is important to monitoring, reviewing and intensive caring in CHD infants during convalescent period after CPB operation.