摘要
目的探讨体外循环下心脏手术术后血淀粉酶水平与患者短期预后的关系。方法选取2017年1月～2018年1月于武汉亚洲心脏病医院新疆医院实施体外循环心脏手术的患者121例,分别于入院时、术后24 h、48 h、72 h,测定所有患者的血淀粉酶水平,根据患者术后血清淀粉酶水平是否达到正常值高限的3倍,分为高淀粉酶血症组(≥450 U/L,n=58)和非高淀粉酶血症组(<450 U/L,n=63)。分析体外循环心脏手术患者血淀粉酶与降钙素原(PCT)、白细胞计数(WBC)、C-反应蛋白(CRP)水平的相关性;记录并比较两组患者的临床资料,呼吸机使用时间、住ICU时间、合并症(包括院内感染、肝功能不全、肾功能不全、多器官功能障碍综合征、术中低血压、术后低心排出量综合征)和院内死亡发生情况。结果两组性别、年龄、手术类型、酗酒史、糖尿病史等临床资料比较差异无统计学意义(P>0.05);患者术后血淀粉酶水平、WBC、CRP水平均升高,术后48 h均达到峰值,而后逐渐降低;术后血清PCT水平有所升高,术后24 h达到峰值后逐渐降低,不同时刻上述指标水平比较均存在统计学差异(P<0.05)。经Pearson相关性分析,患者血淀粉酶水平与WBC、CRP呈正相关(r=0.724、0.685,P=0.009、0.021),与血清PCT水平无明显相关性(r=0.248,P=0.132)。高淀粉酶血症组院内感染、肾功能不全、多器官功能障碍综合征、术中低血压、术后低心排出量综合征发生率均高于非高淀粉酶血症组,且院内死亡高于非高淀粉酶血症组,组间比较存在统计学差异(P<0.05)。结论体外循环心脏术后高淀粉酶血症的发生与早期炎症反应有关,对预后有不良影响,其中术中低血压、术后低心排出量综合征可能是诱发高淀粉酶血症的重要因素。
Objective To discuss the relationship between hemodiastase and short-term prognosis in patients undergone open-heart surgery with cardiopulmonary bypass(CPB).Methods The patients(n=121)were chosen from Xinjiang Hospital of Wuhan Asian Heart Hospital from Jan.2017to Jan.2018.The level of hemodiastase was detected in all patients respectively at time of hospitalization and after the operation for24h,48h and72h.All patients were divided,according to whether or not postoperative hemodiastase level reached3times of the maximum limit of normal value,into hyperamylasemia group(≥450U/L,n=58)and non-hyperamylasemia group(<450U/L,n=63).The correlation among hemodiastase,procalcitonin(PCT),white blood cell count(WBC)and C-reactive protein(CRP)was analyzed.The clinical data,hours of using ventilator,ICU stay time,incidence of complication(hospital infection,hepatic insufficiency,renal insufficiency,multiple organ dysfunction syndrome,intraoperative hypotension,postoperative low cardiac output syndrome)and hospital death were recorded and compared in2groups.Results The difference in sex,age,surgery types,drinking history and diabetes history had no statistical significance between2groups(P>0.05).The levels of hemodiastase,WBC and CRP increased after the surgery,and reached peak value after48h then decreases gradually.The level of PCT increased and reached peak value after24h then decreased gradually.The comparisons in the above indexes had statistical difference at different time points(P<0.05).The results of Pearson correlation analysis showed that the level of hemodiastase was positively correlated to WBC(r=0.724,P=0.009)and CRP(r=0.685,P=0.021),and had no significant correlation to serum PCT(r=0.248,P=0.132).The incidence of hospital infection,renal insufficiency,multiple organ dysfunction syndrome,intraoperative hypotension,postoperative low cardiac output syndrome was higher,and hospital death rate were higher in hyperamylasemia group than those in non-hyperamylasemia group(P<0.05).Conclusion The occurrence of hyperamylasemia is correlated to early inflammatory reactions and has adverse influence on prognosis after open-heart surgery with CPB.The intraoperative hypotension and postoperative low cardiac output syndrome may be important factors inducing hyperamylasemia.
作者
高洪锋
程端
雷静
王敏
杨露铭
Gao Hongfeng;Cheng Duan;Lei Jing;Wang Min;Yang Luming(ICU,Xinjiang Hospital of Wuhan Asian Heart Hospital,Urumqi 830000,China)
出处
《中国循证心血管医学杂志》
2018年第11期1322-1324,1331,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
新疆维吾尔自治区卫生计生委青年医学科技人才专项科研项目(2015Y45)
关键词
血淀粉酶
体外循环
心脏手术
预后
高淀粉酶血症
Hemodiastase
Cardiopulmonary bypass
Cardiac surgery
Prognosis
Hyperamylasemia
