非体外循环冠状动脉搭桥术后早期SIRS发生的危险因素

Risk factors for development of SIRS in patients after off-pump coronary artery bypass grafting

目的分析非体外循环冠状动脉搭桥术（OPCABG）患者术后早期全身炎性反应综合征（SIRS）发生的危险因素。方法择期OPCABG患者60例，年龄46～73岁，NYHAⅠ或Ⅱ级，体重54～110kg。于术后4h时采用EHSA法测定血浆IL-6及IL-10浓度；术后24h内进行SIRS评分，根据SIRS评分，分为2组，SIRS组（S组，SIRS评分≥2分）和非SIRS组（U组，SIRS评分〈2分）。采用logistic回归分析，筛选SIRS发生的危险因素。结果术前单核细胞百分比、血红蛋白浓度及术后血浆IL6、IL-10浓度与术后早期SIRS的发生有关（P〈0．05），回归方程为：Y=0．155＋0．52X1＋0．39X2＋0．76X3-0．79X4。结论术前单核细胞百分比、血红蛋白浓度及术后血浆IL-6浓度、IL10浓度是OPCABG患者术后早期SIRS发生的危险因素。

Objective To determine the risk factors for the development of systemic inflammatory response syndrome （SIRS） in patients after off-pump coronary artery bypass grafting （OPCABG）. Methods Sixty NYHA Ⅰ or Ⅱ patients, aged 46-73 yr, weighing 54-110 kg, undergoing OPCABG, were studied. Blood samples from internal jugular vein were taken for determination of the plasma concentrations of IL-6 and IL-10 at 4 h after the surgery by ELISA. SIRS score was performed during 24 h after the surgery. The patients were divided into 2 groups： SIRS group （S, SIRS score≥2） and non-SIRS group （U, SIRS score 〈 2）. Factors including age, sex, weight, percentage of mononuclear cells, concentration of hemoglobin, time of operation, left ventricular ejection fraction, whether using proteinase inhibitor or not during surgery and plasma concentrations of IL-6 and IL-10 at 4 h after surgery were recorded. The risk factors were identified by logistic regression analysis. Results Logistic analysis indicated that percentage of mononuclear cells, concentration of hemoglobin, the plasma concentrations of IL-6 and IL-10 were closely related with the development of SIRS in patients after OPCABG （P 〈 0.05）, Y = 0. 155 ＋ 0.52 X1 ＋ 0.39 X2 ＋ 0.76X3 - 0.79X4. Conclusion The percentage of mononuclear cells, concentration of hemoglobin, and plasma concentrations of IL-6 and IL-10 after surgery can be the risk factors for the development of SIRS in patients after OPCABG.