先天性心脏病患儿体外循环术后中性粒细胞与淋巴细胞比值变化及其预后的关系  

Correlation between neutrophil to lymphocyte ratio changes and prognosis in children with congenital heart disease after cardiopulmonary bypass

作　　者：褚敏君 仁赵玲 高简 李俊贤 王晓聪 康金锁 陈蓉 Chu Minjun;Ren Zhaoling;Gao Jian;Li Junxian;Wang Xiaocong;Kang Jinsuo;Chen Rong(Department of Clinical Laboratory,Yunnan Fuwai Cardiovascular Hosptial,Yunnan Kunming 650000,China)

机构地区：[1]云南省阜外心血管病医院检验科,昆明650000 [2]中国医学科学院协和医学院阜外医院实验诊断中心,北京100037

出　　处：《中国体外循环杂志》2024年第4期277-281,共5页Chinese Journal of Extracorporeal Circulation

基　　金：云南省科技厅科技计划项目(202301AY070001-296)。

摘　　要：目的探讨先天性心脏病患儿心肺转流(CPB)后中性粒细胞与淋巴细胞比值(NLR)水平变化及其与预后情况的关系。方法选取2019年1月至2022年12月因先天性心脏病在本院接受CPB手术的1岁以下婴幼儿150例,根据CPB时间分为CPB<120 min组和CPB≥120 min组。收集并分析患者基线资料、血常规检查结果及术后情况(包括术后感染,机械通气时间,住ICU时间以及住院时间),评估NLR变化规律与CPB预后之间的关系。使用MannWhitney U检验比较组间差异。采用重复测量方差分析比较不同CPB时长患儿围手术期NLR值差异。结果CPB术后NLR呈现先升高后降低趋势,NLR峰值出现在术后第1~2天。不同CPB时长患儿术前、手术当日及术后1 d的NLR差异无统计学意义(P>0.05),从术后第2天开始,CPB≥120 min患儿NLR值均高于CPB<120 min组患儿(均P<0.01)。术后发生感染、机械通气时间≥72 h、ICU住院时间≥72 h以及术后住院时间≥10 d的患儿到达NLR峰值的时间更长,且术后住院时间≥10 d的患儿术后NLR峰值更高(均P<0.01)。结论CPB手术时间长短可对术后NLR恢复趋势造成影响,术后NLR达峰时间长的患儿易出现预后不良情况。若患儿术后NLR达峰时间推迟,应注意及时采取措施预防术后感染及并发症。Objective To investigate the changes of neutrophil to lymphocyte ratio(NLR)and its relationship with prognosis in children with congenital heart disease(CHD)after cardiopulmonary bypass(CPB).Methods A total of 150 young children under 1 year old who underwent CPB surgery in our hospital due to CHD from January 2019 to December 2022 were selected for analysis,and were divided into CPB<120min group and CPB≥120min group according to CPB time.Baseline data,blood routine examination,and postoperative outcomes(including postoperative infections,mechanical ventilation time,ICU stay,and hospital stay)were collected and analyzed to evaluate the relationship between changes in NLR and prognosis of CPB.The Mann-Whitney U test was used to compare differences between groups.Repeated measures ANOVA was employed to compare perioperative NLR values among patients with different CPB.Results After CPB,NLR exhibited an initial increase followed by a decrease,with the peak occurring on postoperative day 1-2.There were no significant differences in NLR between the two CPB duration groups preoperatively,on the day of surgery,and 1 day after surgery(P>0.05).However,from postoperative day 2 onwards,patients with CPB≥120 min had significantly higher NLR values compared to those with CPB<120 min(all P<0.01).Patients who experienced postoperative infection,mechanical ventilation for≥72 hours,ICU stay for≥72 hours,and total hospitalization time for≥10 days had longer times to reach the NLR peak,and those with hospitalization≥10 days had significantly higher postoperative NLR peaks(P<0.01).Conclusion The duration of CPB surgery can impact the postoperative NLR recovery trend,with longer times to reach the NLR peak being associated with adverse prognosis.Delayed peak times of postoperative NLR should prompt timely measures to prevent postoperative infections and complications.

关 键 词：心肺转流 先天性心脏病 中性粒细胞与淋巴细胞比值 预后 

分 类 号：R726.5[医药卫生—儿科]