临床外周灌注参数对于心脏外科术后早期并发症的预测意义

Significance of peripheral perfusion parameters for predicting early complications after cardiac surgery

目的 明确外周灌注评价指标是否对于心脏外科早期并发症有预测价值。方法 随机选取上海交通大学附属胸科医院2014年10月至2015年3月间行心脏外科手术的111例患者为研究对象。患者术中均行体外循环,术后[术后当天（D0）,术后第1天（D1）、第2天（D2）、第3天（D3）]收集外周灌注参数,术前1 d的外周灌注参数作为基线对照（BL）。外周灌注参数包括毛细血管再充盈时间（CRT）,外周灌注指数（PPI）,以及前臂-指尖温度差（Tskin-diff）。综合这些参数预测患者术后10 d内并发症的发生情况。结果 与未发生并发症患者（92例）的参数相比较,术后发生并发症患者（19例）的外周灌注参数有着显著的差异。其中以毛细血管再充盈时间的D0值,外周灌注指数及前臂-指尖温度差的D1、D2值最为显著。D2、D3的异常外周灌注参数是心脏外科手术严重并发症的独立预测因子（D2：OR=8.4,95%CI=2.7~25.9;D3：OR=6.4,95%CI=2.1~19.6）。结论 外周灌注参数异常与术后并发症发生相关,可作为心脏外科早期并发症发生的独立预测指标。

Objectives To determine whether repeated assessments of peripheral perfusion after surgery could help in early identification of patients that are more likely to develop postoperative complications. Methods Peripheral perfusion parameters were collected one day prior to surgery （BL）, directly after surgery （DO） and on the first （D1）, second （D2） and third （D3） postoperative days in 111 patients who were performed cardiac surgery from October 2014 to March 2015 in Shanghai Chest Hospital. Peripheral perfusion assessment consisted of capillary refill time （CRT）, peripheral perfusion index （PPI） and forearm-finger skin temperature gradient （Tskin-diff）. Peripheral perfusion parameters were used to predict severe complications within 10 days after surgery. Results Severe complications were observed in 19 patients （17.0%）. Postoperatively, peripheral perfusion parameters were significantly altered in patients who subsequently developed severe complications compared to those who did not, and these parameters persisted over time. CRT was altered at DO, PPI and Tskin-diff were altered on D1 and D2. Abnormal peripheral perfusion parameters on D2 and D3 were independent predictors of severe postoperative complications （D2： OR=8.4, 95%CI=2.7-25.9; D3： OR=6.4, 95% CI=2.1-19.6） . Conclusiolls Peripheral perfusion alterations are associated with the development of severe complications, and they can be the independent predictive indexes of early complications after cardiac surgery.