婴儿心脏手术中胸腺切除对术后细胞免疫功能的影响

Effect of Thymectomy on Cellular Immune Function in Infant Heart Surgery

目的:观察胸腺切除对先天性心脏病患儿术后细胞免疫功能的影响。方法:收集本院56例先天性心脏病行开胸心脏手术患儿,采用随机数字表法分为胸腺全切除组29例(研究组)和保留胸腺组27例(对照组)。观察两组患儿术前、术后外周血T淋巴细胞计数水平,记录两组患儿术后心包总引流量、呼吸机辅助时间、血管活性药物使用剂量和时间、ICU滞留时间和住院天数等数据,并术后随访6个月内患感染性疾病的次数和抗生素使用时间。结果:研究组术后7天,术后1个月淋巴细胞计数较对照组均显著降低(P<0.01),术后总引流量、呼吸机辅助时间、多巴胺剂量和使用时间、ICU滞留时间以及住院时间与对照组比较无统计学差异(P>0.05)。术后两组人均患感染性疾病次数无显著差异(P>0.05),但人均使用抗生素时间研究组显著高于对照组(P<0.05)。结论:先天性心脏病患儿行心脏手术时建议保留胸腺组织。

Objective:To investigate the effect of thymectomy on cellular immune function in infants with congenital heart disease.Method:56 infants with congenital heart disease who underwent open-heart surgery in our department were collected and randomly divided into a total thymectomy group(study group,n=29)and a thymic sparing group(control group,n=27).Peripheral blood T lymphocyte count levels of the two groups were observed preoperatively and postoperatively,and postoperative drainage volume,ventilator-assisted time,dose and time of vasoactive drugs,ICU residence time,days of hospitalization and other data of the two groups were recorded.The number of infectious diseases and time of antibiotic use were also observed within 6 months after postoperative follow-up.Results:The lymphocyte counts in the study group were statistically lower than those in the control group 7 days after the surgery and 1 month after the surgery(P<0.01).The differences in postoperative total drainage volume,ventilater-assisted time,dopamine dose and use time,ICU residence time and hospitalization time were not significant(P>0.05).There was no significant difference in the frequency of postoperative infectious diseases per capita(P>0.05),but the time of antibiotic use per capita in study group was longer than in control group(P<0.05).Conclusion:It is recommended that the baby's thymus tissue be preserved during heart surgery.