术前孤立性CRP升高与体外循环术后并发症的相关性  

CORRELATION BETWEEN AN ISOLATED PREOPERATIVE INCREASE OF C-REACTIVE PROTEIN-VALUES AND COMPLICATIONS AFTER EXTRACOREAL CIRCULATION-OPERATION

作　　者：刘林[1] 曹振飞[1] 曾伟生[1] 蒋仁超[1] 刘岩[1] 

机构地区：[1]广州军区广州总医院心胸外科,510010

出　　处：《中国现代医学杂志》2001年第7期48-49,共2页China Journal of Modern Medicine

摘　　要：目的 :探讨无感染的、术前孤立性C -反应蛋白 (CRP)增加 ,对于体外循环心脏术后的结果 ,是否有预测性价值。方法 :分术前孤立性CRP升高 (10 .5～ 70 .2mg/L) 5 0例 (A组 )与CRP正常 (<10mg/L) 5 0例对照 (B组 ) ,B组匹配A组在年龄、性别和疾病种类 ,两组均进行体外循环心脏手术。结果 :A组脓毒性并发症 (2 0 % )比对照组 (2 % )多 (P <0 .0 1)。这些病人微生物学阳性仅 10 %。A组中需要儿茶酚胺支持的占 2 8% ,而B组仅 12 % (P <0 .0 5 )。A组较B组术后需呼吸机支持的时间明显延长 (2 5 .2± 6 .2h比 6 .6± 0 .5h) (P <0 .0 1)、ICU滞留时间也较B组长 (4 .6± 0 .8d比 2 .6± 0 .3d) (P <0 .0 5 )。结论 :术前孤立性CRP升高的病人 ,体外循环术后 ,发生脓毒性并发症的可能性明显增加。且大多数病例微生物学实验阴性 。Objective:Whether an isolated preoperative icrease of C-reaction protein (CRP) without further signs of infection is of any prognostic value for postoperative outcome after cardiac surgery with cardiopulmonary bypass(CPB) was discussed.Methods:Fifty patiens with an isolated CRP-elevation (>10mg/L)(from 10.5 to 70.2mg/L)were operated using CPB (group A).A control group (group B)consisted of 50 cardiac surgery patients,matched in the age,gender and kind of disease.No preoperative CRP-elevation (from 0 to 9.8mg/l) occurred in this group.Results:Septic complications were seen more often in group A(20%) than in the controls(2%) (P<0.01).Microbiology (blood culture,culture from nose,tracheal aspirate and urine) were positive only in 10% of these patients.Catecholamine support (epinephrine,norepinephrine and/or doses of dopamine or dobutamine of more than 3μg/kg per min)was needed in 28% of group A cases,whereas it was only needed in 12% of group B(P<0.05).A singnificantly longer respisatory support was also necessary in patients with elevated CRP (25.2±6.2h vs 6.6±0.5h)(P<0.01).Furthermone there was a significant difference in the duration of intensive care (4.6±0.8day vs 2.6±0.3days)(P<0.05).Conclusions:These date show that patients without apparent infection or inflamation,who had elevated CRP-values preoperatively,face an increased risk of septic complication after extracorporeal circulation.As microbiology tests are negative in most cases,it may be speculated that majority of septic complications due to a systemic inflammatory response syndrome(SIRS).

关 键 词：C-反应蛋白 术后并发症 全身炎症反应综合征 体外循环 

分 类 号：R654.1[医药卫生—外科学]