体外循环心脏术后高淀粉酶血症的危险因素分析（英文）

Risk factor analysis for hyperamylasemia after open-heart surgery

目的：分析体外循环心脏术后患者发生高淀粉酶血症的相关危险因素,为临床预防和治疗提供依据。方法：选择从2013年1月1日至2013年6月30日我院在全麻低温体外循环下行心脏手术后成人患者521例。于入ICU即刻、术后24h、48h、72h抽取外周静脉血2ml,分离血清后用Somogyi法测定血清淀粉酶水平。根据血清淀粉酶测定结果将患者分为高淀粉酶血症组（血淀粉酶≥500U/dl,76例）、非高淀粉酶血症组（血淀粉酶〈500U/dl,445例）。采用单因素和逐步Logistic回归方法分析体外循环心脏术后患者发生高淀粉酶血症的危险因素。结果：逐步Logistic回归分析显示术中体外循环时间、术中低血压、术后肾功能不全、术后感染是术后发生高淀粉酶血症的独立危险因素（OR=1.02~4.12,P〈0.05或〈0.01）。结论：在体外循环心脏手术围术期治疗中,缩短体外循环时间,避免术中低血压,维护肾功能及预防感染,可能会减少术后高淀粉酶血症的发生率,从而改善患者的预后。

Objective：To analyze relative risk factors of hyperamylasemia after open-heart surgery,and provide basis for clinical prevention and treatment.Methods：A total of 521 adult patients,who received open-heart surgery under general anesthesia and low temperature in our hospital from Jan 1,2013 to Jun 30,2013,were selected.The 2ml peripheral venous blood was taken in each patient instant after ICU hospitalization,24 h,48h and 72 h after surgery,then serum was separated and measured for serum amylase level by Somogyi method.According to the measured results of serum amylase level,patients were divided into hyperamylasemia group（serum amylase≥500U/dl,n=76）and non-hyperamylasemia group（serum amylase500 U/dl,n=445）.Single factor and gradual Logistic regression analysis were used to analyze ridk factors of hyperamylasenia in patients after open-heart surgery.Results：Gradual Logistic regression analysis indicated that cardiopulmonary bypass（CPB）time and hypotension during operation,renal dysfunction and infection after operation were independent risk factors for postoperative hyperamylasemia（OR=1.02~4.12,P〈0.05 or0.01）.Conclusion：During perioperative treatment of open-heart surgery,shortening CPB time,avoiding hypotension during surgery,protecting renal function and preventing infection may reduce morbidity of postoperative hyperamylasemia and improve prognosis of patients.