体外循环后胆碱酯酶水平与全身炎症反应综合征 和并发症的关系研究  

Relationship among cholinesterase level,systemic inflammatory response syndrome and complications after cardiopulmonary bypass

作　　者：魏廷举 赵俊杰[1] 徐大千[2] 冯琛灿 刘安康 徐敬[1] Wei Tingju;Zhao Junjie;Xu Daqian;Feng Chencan;Liu Ankang;Xu Jing(Department of Cardiovascular Surgery,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;不详)

机构地区：[1]郑州大学第一附属医院心血管外科,郑州450052 [2]郑州大学第一附属医院外科重症监护室,郑州450052

出　　处：《中国循证心血管医学杂志》2024年第8期972-976,1003,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220283)

摘　　要：目的探讨体外循环(CPB)后胆碱酯酶水平变化以及与全身炎症反应综合征(SIRS)的关系,进一步研究其对多器官功能障碍综合征(MODS)的预测价值。方法本研究对2021年2月至2022年12月期间于郑州大学第一附属医院计划接受CPB下心脏手术的患者进行前瞻性分析。其中48例患者发生SIRS作为SIRS组,另外50例未发生SIRS作为对照组。数据收集时间:术前(H0),ICU入院后4 h(H4)、8 h(H8)、12 h(H12)、24 h(H24)和48 h(H48)。通过现场及时检测技术测量血清丁酰胆碱酯酶(BChE)活性,并用血红蛋白(Hb)校正。评估H24和H48时血清BChE活性与急性生理学和慢性健康评估Ⅱ(APACHEⅡ)评分之间的相关性。利用受试者操作特征(ROC)曲线分析BChE活性对CPB后SIRS患者MODS的预测效能。结果SIRS组患者预后更差,包括H24和H48时APACHE II和序贯器官衰竭(SOFA)评分均高于对照组(P<0.05),且ICU住院时间更长(P=0.030)。SIRS组和对照组在术后H12时血清BChE活性降至最低值,分别为1.16(0.73,1.47)×10^(3) U/g Hb和0.82(0.71,1.0)×10^(3) U/g Hb。且SIRS组血清BChE水平在H8-H48期间一直低于对照组(P<0.05)。经Spearman相关分析,SIRS患者H24时血清BChE含量与APACHEII评分之间存在负相关关系(r=-0.381,P=0.009)。SIRS组中19例患者进展至MODS,其中15例发生在ICU H24~H48期间。MODS组患者H8-H48期间血清BChE水平一直低于非MODS组(P<0.05)。最后,利用H8和H12血清BChE预测MODS风险,ROC曲线结果显示,当H8 BChE≤0.98×10^(3) U/g Hb或H12≤0.76×10^(3) U/g Hb时,MODS进展风险大大增加,曲线下面积分别为0.748和0.838。结论CPB后SIRS患者血清BChE活性显著降低,CPB术后早期BChE耗竭与SIRS严重程度和MODS进展风险具有密切关系。Objective To discuss the relationship between level changes of cholinesterase(ChE)and systemic inflammatory response syndrome(SIRS)after cardiopulmonary bypass(CPB),and study the predictive value of ChE to multiple organ dysfunction syndrome(MODS).Methods The patients received heart surgery under CPB were prospectively analyzed in the First Affiliated Hospital of Zhengzhou University from Feb.2021 to Dec.2022.The patients with SIRS were chosen into SIRS group(n=48)and patients withoutSIRS were chosen into control group(n=50).Data collection time was as follows:pre-operation(H0),4 hours(H4),8 hours(H8),12 hours(H12),24 hours(H24)and 48 hours(H48)after ICU admission.The activity of serum butyrylcholinesterase(BChE)was detected by using point-of-care testing(POCT)and corrected with hemoglobin(Hb).The correlation between BChE activity at time points of H24 and H48 and scores of acute physiology and chronic health evaluationⅡ(APACHEⅡ)was assessed.The predictive efficacy of BChE to MODS by using ROC curve analysis in SIRS patients after CPB.Results The prognosis was poorer,scores of APACHEⅡand sequential organ failure assessment(SOFA)were higher(P<0.05)at time points of H24 and H48,and ICU duration was longer(P=0.030)in SIRS group than those in control group.The activity of BChE decreased to the lowest value at time point of H12 in SIRS group and 33 control group[1.16(0.73,1.47)×10^(3) U/g Hb;0.82(0.71,1.0)×10^(3) U/g Hb].The level of serum BChE was lower in SIRS group all the time than that in control group at time points from H8 to H48(P<0.05).The results of Spearman correlation analysis showed that level of serum BChE at time point of H24 was negatively correlated to APACHEⅡscores(r=-0.381,P=0.009)in SIRS group.In SIRS group,MODS occurred in 19 patients,and MODS occurred at time points from H24 to H48 in 15 patients.The level of serum BChE was lower all the time in MODS group than that in non-MODS group at time points from H8 to H48(P<0.05).The results of ROC curve analysis,3 in prediction of MODS risk by

关 键 词：体外循环 胆碱酯酶 全身炎症反应综合征 多器官功能障碍综合征 

分 类 号：R654[医药卫生—外科学]