超快通道麻醉对小儿心脏手术后C反应蛋白和降钙素原的影响

Effects of Ultra-fast Track Anesthesia on Blood Levels of C-reactive Protein and Procalcitonin in Patients After Pediatric Cardiac Surgery

目的:比较超快通道麻醉方法和传统麻醉方法对于小儿心脏手术后血清高敏C反应蛋白(hs-CRP)、C反应蛋白(CRP)和降钙素原(PCT)含量的影响。方法:回顾分析了2013-09至2014-05由同一位麻醉医师实施的心脏手术101例患儿麻醉资料,根据术后是否在手术室内拔管,术后手术室内拔管的40例为超快通道麻醉组,余44例患儿为传统麻醉组,比较术前(T0)、术后第1天(T1)、术后第2天(T2)三个时间点两组患儿血清hs-CRP、CRP和PCT含量的变化。结果:hs-CRP含量:两组T1、T2时间点较T0时间点升高,差异均有统计学意义(P<0.05);两组间比较,在T1时间点,超快通道麻醉组显著低于传统麻醉组,差异有统计学意义(P<0.05)。CRP含量:在超快通道麻醉组不同时间点差异没有统计学意义,而在传统麻醉组T2时间点较T1时间点增加,差异有统计学意义(P<0.05);两组间比较,在T2时间点,传统麻醉组显著高于超快通道麻醉组,差异有统计学意义(P<0.05)。PCT含量:组内各时点比较均无明显变化;两组间比较,在T1时间点,超快通道麻醉组显著低于传统麻醉组,差异有统计学意义(P<0.05)。结论:与传统麻醉方法比较,超快通道麻醉管理可以减少术后hs-CRP、CRP和PCT含量的升高,有可能减少心脏手术后的呼吸机相关肺炎的发生。

Objective： To compare the effects of ultra-fast track anesthesia and traditional anesthesia on blood levels of high sensitivity C-reactive protein （Hs-CRP）, C-reactive protein （CRP） and procalcitonin （PCT） in patients after pediatric cardiac surgery. Methods： A total of 101 patients received pediatric cardiovascular surgery by a same anesthesiologist in our hospital from 2013-09 to 2014-05 were retrospectively reviewed. The patients were studied in 2 anesthesia groups： Ultra-fast track group, in which the extubation was conducted in operating room, n=40 and Traditional group, n=44. Blood levels of Hs-CRP, CRP and PCT at pre-operation （TO）, 1^st day post-operation （T1） and 2^nd day post-operation （T2） were compared. Results：（1） Hs-CRP levels were higher at T1 and T2 than TO in both groups, all P〈0.05; Hs-CRP level in Ultra-fast track group was lower than Traditional group at T1 time point, P〈0.05. （2） CRP levels were similar among 3 time points in Ultra- fast track group; while in Traditional group, CRP level at T2 was higher than T1, P〈0.05; CRP level was higher in Traditional group than Ultra-fast track group at T2, P〈0.05. （3） PCT levels at 3 time points were similar in the same group; while PCT level in Ultra-fast track group was lower than Traditional group at T1 time point, P〈0.05. Conclusion： Compared With traditional anesthesia, ultra-fast track anesthesia could decrease the post-operative elevations of Hs-CRP, CRP and PCT in patients after pediatric cardiac surgery.