体外循环心脏术后高淀粉酶血症对预后的影响

Effect of postoperative hyperamylasemia on prognosis of patients with cardiopulmonary bypass

目的:分析体外循环心脏术后患者发生高淀粉酶血症对预后的影响。方法:选择在全麻体外循环心脏手术的成人患者100例,于入住ICU即刻、术后24、48、72 h比较血淀粉酶水平,并分析与血白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)等炎性指标之间的相关性。根据血淀粉酶测定结果将患者分为A组18例(血淀粉酶≥500μ/d L)、B组38例(150μ/d L≤血淀粉酶<500μ/d L)、C组34例(血淀粉酶<150μ/d L),比较3组间肾功能不全、肝功能不全、胃肠功能不全、院内感染、多器官功能障碍综合征(MODS)的发生率、机械通气时间、ICU留治时间、住院时间、院内病死率。比较3组间糖尿病病史、酗酒史、术中低血压、术后低心排的发生率。结果:体外循环心脏手术患者血淀粉酶变化与WBC、CRP呈正相关性,与PCT无直线关系;A组肾功能不全、院内感染、MODS的发生率均明显高于C组(均P<0.05);A组ICU留滞时间、院内病死率明显高于C组(P<0.05);A组术中低血压、术后低心排的发生率均明显高于C组(P<0.05)。结论:体外循环心脏术后患者血淀粉酶水平与术后早期炎症反应有关。体外循环心脏手术患者发生高淀粉酶血症提示预后不佳,术中低血压、术后低心排可能是导致高淀粉酶血症的因素。

Objective： To analyze the effect of postoperative hyperamylasemia on prognosis of patients with cardiopulmonary bypass. Methods： 100 postcardiac surgery patients with general anaesthesia and cardiopulmonary bypass during the study period of August 1st,2012 to January 31 st,2013 were enrolled in the study. The serum amylase,WBC,CRP and PCT were measured immediately at the admission to ICU,24 h,48 h and 72 h after operation,and the relationship between serum amylase with WBC,CRP and PCT was analyzed. The patients were divided into three groups according to the serum amylase levels. The morbidity of renal insufficiency,hepatic insufficiency,gastrointestinal function failure,infection in hospital,multiple organ dysfunction syndrome,the time of mechanical ventilation,time of staying in ICU,and mortality in hospital were compared. The diabetes mellitus,intemperance,hypotension,and low cardiac output were recorded. Results： WBC and CRP were related to postoperative hyperamylasemia,but PCT was not related to postoperative hyperamylasemia. The mortality in hospital and the morbidity of renal insufficiency,infection in hospital,multiple organ dysfunction syndrome in group A were significantly higher than in group C（ P〈0.05）. The time of staying in ICU in group A was significantly longer than in group C（ P〈0.05）. The morbidity of hypotension and low cardiac output in group A was significantly higher than in group C. Conclusions： The inflammation reaction was correlated with postoperative hyperamylasemia after cardiac operation with cardiopulmonary bypass. The postoperative hyperamylasemia revealed worse prognosis. Hypotension and low cardiac output may be the causes of hyperamylasemia.