Hikmet KOÇAK, Yahya ÜNLÜ, Şule KARAKELLEOĞLU, Zuhal UMUDUM, Münacettin CEVİZ

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Koroner bypass cerrahisinde miyokard hasarının belirlenmesinde kardiyak troponin T'nin değeri

Miyokardiyal hasarın tespitinde kardiyak troponin T, kreatin kinaz-MB' den çok daha spesifik ve sensitiftir. Bu çalışmada, koroner bypass'dan sonra meydana gelebilecek kardiyak olay riskleri, preoperatif, perioperatif ve postoperatif kardiyak troponin T seviyelerini tespit ederek değerlendirdik. Yöntem: Açık kalp cerrahisi uygulanan 25 olgu çalışma grubunu, kardiyak cerrahi dışındaki 15 olgu kontrol grubunu oluşturmuştur. Tüm olgulardan anestezi öncesi, kardiyopulmoner bypass esnasında, postoperatif 1. saat, 2. saat, 2. gün, 3. gün, 4. gün ve 5. günlerde kan örnekleri alınmıştır. Bulgular: Her iki grupta da kreatin kinaz-MB, kreatin kinaz, laktik dehidrogenaz, glutamik-oxalasetik transaminaz ve glutamik-piruvik transaminaz düzeyleri, preoperatif düzeylere göre anlamlı olmayan artış gösterirken (p > 0.05), kardiyak troponin T düzeyi sadece açık kalp cerrahisi uygulanan grupta yükselmiştir (p < 0.05). Sönüp: Preoperatif kardiyak troponin T düzeyinin tespiti, postoperatif kardiyak komplikasyon riski yüksek olabilecek olguların belirlenmesinde kullanılabilir. Aynı zamanda, perioperatif ve postoperatif kardiyak troponin T düzeylerinin tespiti, farklı miyokard koruma tekniklerinin karşılaştırılması bakımından da faydalı olabilir.

The value of cardiac troponin T to determine myocardial injury in coronary artery bypass surgery

Cardiac troponin T is more specific and sensitive marker for myocardial injury than MB isoenzyme of creatine kinase. We studied the prognostic value and cardiac risks after than coronary artery bypass grafting, measuring of the preoperative, perioperative and postoperative serum levels of the cardiac troponin T in this study. Patients: We studied with 25 patients who underwent elective coronary artery bypass grafting (Group I) and 15 patients underwent noncardiac surgery (as a control group) (Group II). Blood samples were collected before the induction of anesthesia, during the cardiopulmonary bypass, 1st, 2nd hours of operation, 2nd, 3rd, 4th and 5th days after the operation. Results: Serum levels of MB isoenzyme of creatine kinase, creatine kinase, lactate dehydrogenase, glutamic, oxalacetic transaminases and glutamic pyruvic transaminases in the both groups showed unimportant increase according to preoperative levels (p > 0.05), while cardiac troponin T values increased only in cardiopulmonary bypass group (p < 0.05). Conclusion: Preoperative cardiac troponin T stratification before coronary artery bypass grafting identifies a subgroup of patients with increased risk of postoperative cardiac complications. Also, the measurement of perioperative and postoperative cardiac troponin T levels may be a useful method for comparing different myocardial protection techniques.
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Atatürk Üniversitesi Tıp Dergisi (Y. A. The Eurasian Journal of Medicine)-Cover
  • ISSN: 1300-7254
  • Yayın Aralığı: 4
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