Perioperatif Miyokardiyal Hasar Tespitinde Biyokimyasal Belirleyicilerin Rolü
Yükleniyor...
Dosyalar
Tarih
2002
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi Tıp Fakültesi Dergisi
Erişim Hakkı
Attribution 3.0 United States
Özet
Perioperatif miyokard infarktüs tanısı geleneksel olarak elektrokardiogramla ve kreatin kinaz izoenziminin (CKMB)
yükselmiş serum değerleriyle konur. Kardiyak troponin I (cTnI) miyokardiyal hasarlanmalarda yaygın
kullanılan enzimlere göre daha güvenilir ve sipesifik bir belirleyicidır. Bu çalışma, açık kalp cerrahisi sırasında
oluşan miyokardiyal hasarı değerlendirmede kardiyak enzimlerin spesifite ve sensitivitelerini karşılaştırmak
amacıyla planlandı.
Açık kalp cerrahisi uygulanan 52 olgu çalışmaya alınmıştır. Bu gruptaki olguların 39’u erkek, 13’ü kadın olup
ortalama yaş 58±2(17-75) dir. Hastalardan; anestezi indüksiyonundan önce, kross klemp sonrası(0.saat), kross
klempten 6, 12, 24, 48, 72, 96 ve 120 saat sonra venöz kanlardan CK, CK-MB ve cTnI, postoperatif 2. ve 9.
saatlerde kardiyak miyoglobin calışıldı ve günlük EKG alındı.
Hastalarda mortalite olmadı. İki hastada perioperatif miyokardiyal infarktüs tanısı kondu. Kapak lezyonu olan
hastalarda, kross-klemp süresi 60 dakikanın üzerinde olan hastalarda ve inotrop kullanılan hastalarda kardiyak
belirleyici düzeyleri daha yüksek tespit edildi. Ayrıca bazı hastalarda CK ve CK-MB değerleri normal olmasına
rağmen cTnI değerleri yüksek olarak tespit edildi.
Sonuç olarak; cTnI yaygın olarak kullanılan serum enzimleri ile kıyaslandığında kardiyak hasar tanısını koymada
daha sipesifik bir belirleyicidir. Diğer belirleyicilere oranla daha küçük miyokardiyal hasarlar tespit edilebilir. cTnI
düzeyinin tespiti çeşitli miyokard koruma tekniklerinin karşılaştırılması açısından olduğu kadar, oluşan miyokard
hasarını erken dönemde göstermesi ve düzeyi hakkında bilgi vermesi açısından da faydalı bir tetkikdir.
Perioperative infarction is traditionally diagnosed by the electrocardiogram and elevated serum levels of creatine kinase izoenzyme (CK-MB). Cardiac troponin I (cTnI) is a more reliable and specific marker for myocardial damage when compared to commonly used serum enzymes. We planned this study for comparing the specifity and the sensitivity of cardiac enzymes in detecting the myocardial injury in patients undergoing open heart surgery. Fifty two cases who underwent open heart surgery were included in this study. There were 39 males and 13 females with a median age of 58±2(17-75). Venous blood samples were collected to analyze CK, CK-MB and cTnI prior to induction of anesthesia, immediately after cross-clamp and at 6 hours,12 hours and 24 hours following surgery and daily thereafter until the fifth postoperative day. Venous blood samples were also collected to analyze cardiac myoglobin upon the termination of the operation and at 2 hours and 9 hours following the operation. Daily electrocardiograms were obtained for all patients. There was no mortality during the study. Peroperative myocardial infarction was detected in two patients. Higher cardiac marker levels were detected in patients who had valvular surgery, who had cross-clamp duration over 60 minutes and who were given inotropic agents. Moreover; in some patients: high cardiac cTnI levels were detected despite normal CK and CK-MB levels. In conclusion; cTnI is a more specific marker of cardiac damage when compared to commonly used serum enzymes. It is also more sensitive, allowing diagnosis of perioperative microinfarction and detection of acute myocardial infarction much earlier after the onset of myocardial injury and comparing different myocardial protection techniques.
Perioperative infarction is traditionally diagnosed by the electrocardiogram and elevated serum levels of creatine kinase izoenzyme (CK-MB). Cardiac troponin I (cTnI) is a more reliable and specific marker for myocardial damage when compared to commonly used serum enzymes. We planned this study for comparing the specifity and the sensitivity of cardiac enzymes in detecting the myocardial injury in patients undergoing open heart surgery. Fifty two cases who underwent open heart surgery were included in this study. There were 39 males and 13 females with a median age of 58±2(17-75). Venous blood samples were collected to analyze CK, CK-MB and cTnI prior to induction of anesthesia, immediately after cross-clamp and at 6 hours,12 hours and 24 hours following surgery and daily thereafter until the fifth postoperative day. Venous blood samples were also collected to analyze cardiac myoglobin upon the termination of the operation and at 2 hours and 9 hours following the operation. Daily electrocardiograms were obtained for all patients. There was no mortality during the study. Peroperative myocardial infarction was detected in two patients. Higher cardiac marker levels were detected in patients who had valvular surgery, who had cross-clamp duration over 60 minutes and who were given inotropic agents. Moreover; in some patients: high cardiac cTnI levels were detected despite normal CK and CK-MB levels. In conclusion; cTnI is a more specific marker of cardiac damage when compared to commonly used serum enzymes. It is also more sensitive, allowing diagnosis of perioperative microinfarction and detection of acute myocardial infarction much earlier after the onset of myocardial injury and comparing different myocardial protection techniques.
Açıklama
İnönü Üniversitesi Tıp Fakültesi Dergisi
9(2) 95-103 (2002)
Anahtar Kelimeler
Kardiyak Troponin I, Kardiyopulmoner Bypass, Miyokardiyal Hasar, Cardiac Troponin I, Cardiopulmonary Bypass, Myocardial Injury
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Hazar, Abdussemet ; Cihan, Hasan Berat ;Gülcan, Öner ;Çığlı, Ahmet ;Özyalın, Fatma ;Türköz, Rıza ;İnönü Üniversitesi Tıp Fakültesi Dergisi 9(2) 95-103 (2002)
