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2017年第3期
老年人非心脏手术后心肌损伤标记物的改变
Changes of myocardiac injury markers activity During Noncardiac Surgery in Aged Patients
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DOI:
作者:
沈亮
shen liang
作者单位:
瑞金医院卢湾分院
Department of Anesthesiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai 200020, China
关键词:
肌红蛋白;肌酸激酶同工酶;N-末端脑钠素前体;非心脏手术;老年患者
Key words: Myocardial myoglobin (Myo), Creatine kinase (CK-MB) and plasma N- terminal pro brain natriuretic peptide (NT-proBNP) , Noncardiac Surgery, Aged Patients
摘要:
【摘要】 目的 通过观察老年人非心脏手术前后心肌损伤标志物的变化,为临床评估老年患者非心脏手术预后提供依据。方法 选择行择期胃、肠道外科手术的老年患者120例,平均年龄65.12±6.72岁。其中男性60例,女性60例,ASAⅡ~Ⅲ。在进入手术室(T1)、麻醉诱导后(T2)、气管插管后(T3)、切皮肤后(T4)、探查腹腔后(T5)、手术结束即刻(T6)、拔管后(T7)各时间点记录血液动力学指标:包括收缩压、舒张压、平均动脉压和心率进行组内比较;以及分别在手术开始前、手术结束后、手术后次日、手术后第二日晨进行心肌酶谱浓度测定:检测心肌肌红蛋白(Myo)、肌酸激酶同工酶 (CK-MB)和血浆N-末端脑钠素前体(NT-proBNP)浓度,进行组内比较和各时间点值与基础值比较 。结果 与手术前比较麻醉诱导后(T2)心率、血压下降显著(P<0.05),而插管后(T3)心率、血压上升显著(P<0.05);心肌酶谱检测中术后第一天血浆N-末端脑钠素前体浓度(NT-proBNP)均高于基础值,并且与术前相比有显著差异(P<0.05)。结论 老年人非心脏手术后会引起心脏标志物血浆NT-proBNP 浓度的升高。对预测患者术后预后有一定临床价值。
Abstract: Attitude: Observe the changes of myocardial injury markers during non cardiac surgery in Aged patients, in order to provide evidence for clinical evaluation of the prognosis of Aged patients undergoing non cardiac surgery. Methods: 120 elderly patients who underwent elective gastric and intestinal surgery were selected with the average age 65.12 ±6.72 years old and ASAII-III. Among them, 60 cases were male, 60 cases were female. The hemodynamic parameters including systolic blood pressure(SBP) diastolic blood pressure(DBP), mean arterial pressure (MAP) and heart rate are recorded after entering the operation room (T1), after induction of anesthesia (T2), after tracheal intubation (T3), cut the skin (T4), after abdominal exploration (T5), at the end of surgery (T6), after extubation (T7) with comparisons of intra-group and the following myocardiac injury markers are respectively checked at the end of surgery before and after surgery, after surgery the first day morning and after surgery the second day morning: detection of myocardial myoglobin (Myo), creatine kinase (CK-MB) and plasma N- terminal pro brain natriuretic peptide (NT-proBNP) concentration, with comparisons of intra-group and compared with baseline values. Results: In T2blood pressure and heart rate decreased significantly(compared with T0, P<0.05).In T3blood pressure and heart rate increased significantly(compared with T0, P<0.05). After surgery the first day morning NT-proBNP are higher than baseline values and increased significantly(compared with those before surgery, P<0.05). Conclusion: The postoperative plasma NT-proBNP concetration is increased at the early stage,then gradually decreased.The increase of plasma NT-proBNP concetration after operation has a certain clinical value in predicting prognosis of the patients.
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