15kg以下先心病患儿术后肌酸激酶同工酶与死亡风险的相关性研究  

Correlation between Postoperative Creatine Kinase-MB and In-hospital Death for Congenital Heart Disease Infants Weighing Less Than 15 kg

作　　者：邹丽华[1] 张浩[2] 刘晋萍[1] 吴树彬[1] 王甜[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院小儿体外循环科,北京100037 [2]中国医学科学院北京协和医学院阜外心血管病医院小儿心脏外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2015年第4期311-316,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金资助项目(81100178);北京协和医学院研究生创新基金资助项目(2013-1002-29)~~

摘　　要：目的分析先天性心脏病患儿术后肌酸激酶同工酶(CK-MB)升高的影响因素及其对死亡事件的预测价值。方法回顾性分析2012年1月至2013年12月期间阜外心血管病医院708例体重低于15 kg行择期手术的先心病患儿的临床资料,其中男269例(38.0%)、女439例(62.0%)。CK-MB取术后住院期间最大值进行分析,按术后CK-MB最大值将患儿分为三组:A组(CK-MB≤25 IU/L),B组(25 IU/L<CK-MB≤125 IU/L),C组(CK-MB>125 IU/L)。结果紫绀型先心病(P=0.002)、主动脉阻断(P=0.030)、体外循环时间(P=0.002)、主动脉阻断时间(P=0.016)、二次转机(P<0.001)、深低温停循环(P=0.024)与术后CK-MB升高独立相关。三组间术后死亡率差异有统计学意义(均为P<0.001)。受试者工作特征(ROC)曲线表明CK-MB对术后住院死亡具有预测价值(P<0.001),最佳临界值为168.5 IU/L,该临界值点敏感度为54.2%,特异度为90.8%,阳性预测值为17.3%,阴性预测值为98.4%。多因素logistic回归表明CK-MB>168.5 IU/L是术后死亡的独立危险因素(OR=6.364,P<0.001)。结论小儿心脏术后CK-MB的升高受多个因素的影响,术后CK-MB重度升高的患儿术后死亡风险增加。Objective To analyze the influencing and prognostic factors for in-hospital death of creatine kinaseMB after cardiac surgery for congenital heart disease in pediatric. Methods Clinical data of 708 children with body weight less than 15 kg who underwent cardiac surgery at Fu Wai Hospital between January 2012 and December 2013 were retrospectively analyzed. There were 269 males（38.0%） and 439 females（62.0%）. The postoperative maximum CKMB was calculated for analysis and patients were devided into three groups： a group A（CK-MB ≤ 25 IU/L）, a group B（25 IU/LCK-MB ≤ 125 IU/L） and a group C（CK-MB125 IU/L）. Results Postoperative CK-MB level was independently associated with cyanotic congenital heart disease（P=0.002）, the aorta cross clamp（P=0.030）, the cardiopulmonary bypass time（P=0.002）, the cross clamp time（P=0.016）, the re-establish of bypass（P〈0.001）, deep hypothermic circulatory arrest（P=0.024）. There was statistical difference in mortality between the 3 groups（P〈0.001）. The receiver operating characteristic curve showed that CK-MB has predictive value for in-hospital death（P〈0.001） and the cutoff value is 168.5 IU/L, with a sensitivity of 54.2%, specificity of 90.8%, positive predictive value of 17.3% and negative predictive value of 98.4%. CK-MB level above 168.5 IU/L was an independent risk factor for in-hospital death（OR=6.364, P〈0.001）. Conclusion Elevation of CK-MB after cardiac surgery is independently influenced by several variables. Pediatric with major CK-MB elevation has high risk of in-hospital death.

关 键 词：心脏手术 肌酸激酶同工酶 死亡 低体重 

分 类 号：R726.5[医药卫生—儿科]