先天性心脏病患者体外循环术后全身炎症反应综合征发生风险评估  

Risk assessment of systemic inflammatory response syndrome after cardiopulmonary bypass in patients with congenital heart disease

作　　者：刘姣 温玉双 李小伟 LIU Jiao;WEN Yu-shuang;LI Xiao-wei(Department of Cardiovascular Surgery,Qinhuangdao Hebei 066000,China;CCU,Qinhuangdao First Hospital,Qinhuangdao Hebei 066000,China)

机构地区：[1]秦皇岛市第一医院心血管外科,河北秦皇岛066000 [2]秦皇岛市第一医院CCU,河北秦皇岛066000

出　　处：《临床和实验医学杂志》2025年第5期461-465,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省医学科学研究课题计划项目(编号:20221623)。

摘　　要：目的探讨先天性心脏病患者体外循环术后全身炎症反应综合征(SIRS)的发生风险。方法回顾性选取2020年6月至2024年6月在秦皇岛市第一医院行体外循环术的先天性心脏病患者,共计80例。根据患者术后有无发生SIRS分为观察组(n=30)和对照组(n=50)。比较两组的临床病例资料[性别、年龄、体外循环时间、体重指数、手术时间、术后48 h内输血量、ICU滞留时间、气管插管持续时间、总出血量、心率、血氧分压(PO 2)]差异,比较两组的炎症因子[白细胞介素(IL)-6、IL-8、IL-10、白细胞计数(WBC)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平和脂氧素A4(LXA4)、吲哚胺2,3-双加氧酶(IDO)、降钙素原(PCT)、外周血中性粒细胞核因子-κB(NF-κB)活性。采用二元Logistic回归分析对体外循环术后发生SIRS的影响因素进行分析。结果两组患者的性别、年龄、体外循环时间、体重指数、手术时间、术后48 h内输血量、气管插管持续时间、总出血量比较,差异均无统计学意义(P>0.05);观察组患者的ICU滞留时间、心率分别为(34.58±10.62)h、(112.60±18.80)次/min,均大于对照组[(15.99±3.75)h、(91.78±13.19)次/min],PO 2水平为(120.23±50.13)mmHg,低于对照组[(160.32±101.10)mmHg],差异均有统计学意义(P<0.05)。观察组术后的IL-6、IL-8、IL-10、TNF-α水平分别为(352.45±110.08)pg/L、(125.64±66.34)pg/mL、(14.16±5.06)pg/L、(0.92±0.34)ng/mL,均高于对照组[(120.24±41.32)pg/L、(28.50±26.25)pg/mL、(5.04±2.01)pg/L、(0.73±0.30)ng/mL],差异均有统计学意义(P<0.05);两组术后的WBC、CRP水平比较,差异均无统计学意义(P>0.05)。观察组术后的LXA4、IDO、NF-κB水平分别为(2.10±1.01)ng/L、(115.25±30.24)U/L、0.92±0.27,均高于对照组[(1.65±0.89)ng/L、(83.07±23.64)U/L、0.71±0.25],差异均有统计学意义(P<0.05);两组术后的PCT水平比较,差异无统计学意义(P>0.05)。经二元Logistic回归分析结果显示,ICU滞留�Objective To investigate the risk of systemic inflammatory response syndrome(SIRS)after cardiopulmonary bypass in patients with congenital heart disease.Methods A total of 80 patients with congenital heart disease who underwent cardiopulmonary bypass in Qinhuangdao First Hospital from June 2020 to June 2024 were retrospectively selected.According to the presence or absence of SIRS after operation,the patients were divided into the observation group(n=30)and the control group(n=50).The clinicopathological data[gender,age,cardiopulmonary bypass time,body mass index,operation time,postoperative blood transfusion volume within 48 h,ICU retention time,tracheal intubation duration,total blood loss,heart rate,and blood partial pressure of oxygen(PO 2)]of the two groups were compared.The levels of inflammatory factors[interleukin(IL)-6,IL-8,IL-10,leukocyte(WBC),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)]and the activity of lipoxin A4(LXA4),indoleamine 2,3-dioxygenase(IDO),procalcitonin(PCT)and peripheral blood neutrophils nuclear factorκB(NF-κB)were compared between the two groups.The influencing factors of SIRS after cardiopulmonary bypass was analyzed using binary Logistic regression analysis.Results There were no statistically significant differences in gender,age,cardiopulmonary bypass time,body mass index,operation time,blood transfusion volume within 48 h after operation,duration of tracheal intubation and total bleeding volume between the two groups(P>0.05).The ICU retention time and heart rate of the observation group were(34.58±10.62)h and(112.60±18.80)times/min,respectively,which were higher than those of the control group[(15.99±3.75)h,(91.78±13.19)times/min],and the PO 2 level was(120.23±50.13)mmHg,which was lower than that of the control group[(160.32±101.10)mmHg],the differences were statistically significant(P<0.05).The levels of IL-6,IL-8,IL-10 and TNF-αin the observation group were(352.45±110.08)pg/L,(125.64±66.34)pg/mL,(14.16±5.06)pg/L and(0.92±0.34)ng/mL,respectively,which we

关 键 词：全身炎症反应综合征 先天性心脏病 体外循环术后 风险评估 

分 类 号：R654.2[医药卫生—外科学]