危重先天性心脏病新生儿手术前后血清25-羟基维生素D水平与预后的相关性

The correlation of serum 25-hydroxyvitamin D levels in neonates with critical congenital heart disease before and after surgery with prognosis

目的研究危重先天性心脏病(CHD)新生儿手术前后血清25-羟基维生素D[25-(OH)D]与预后的相关性。方法以60例危重CHD手术新生儿为研究对象,测定术前(T1)、术毕(进入CCU,T2)、术后24 h(T3)的25-(OH)D水平,评估维生素D缺乏程度;记录T1时不同维生素D缺乏程度患儿的基线资料[包括年龄、体质量、缺损面积、性别、先天性心脏手术风险调整-1(RACHS-1)评分、诊断类型],分析患儿术后24 h内最大血管活性药物评分(VIS)与维生素D水平的关系,根据T3时点维生素D水平将患儿分为缺乏组、不足组及正常组,比较3组患儿24 h胸液量、24 h尿量、机械通气时间、ICU时间住院时间及不良事件发生率。结果新生危重CHD患儿T2、T3时25-(OH)D水平低于T1时点,维生素D缺乏程度高于T1时点(P<0.05);T1时点维生素D缺乏、不足及正常患儿的年龄、体质量、缺损面积、性别、RACHS-1评分及诊断类型比较,差异无统计学意义(P>0.05);新生危重CHD患儿术后24 h内最大VIS评分为(31.75±3.28)分,相关分析发现T2及T3时点25-(OH)D水平与24 h内最大VIS评分呈负相关(r=-0.615、-0.529,P<0.05),T2及T3时点维生素D缺乏程度与24 h内最大VIS评分呈正相关(r=0.466、0.368,P<0.05);新生危重CHD患儿术后24 h内维生素D缺乏组、不足组、正常组胸液量、尿量、机械通气时间、不良事件发生率比较,差异无统计学意义(P>0.05),缺乏组ICU时间、住院时间较不足组和正常组延长,差异有统计学意义(P<0.05)。结论危重CHD手术新生儿在术后24 h内25-(OH)D水平下降,可能与正性肌力支持率升高有关。

Objective To study the correlation between serum 25-hydroxyvitamin D[25-(OH)D]levels before and after surgery and prognosis of neonates with critical congenital heart disease(CHD).Methods A total of 60 neonates with critical CHD were taken as the research objects.Serum 25-(OH)D levels before surgery(T1),after surgery(entering CCU,T2),and 24 hours after surgery(T3)were measured to assess the degree of vitamin D deficiency.The baseline data of these neonates with different levels of vitamin D deficiency was recorded at T1,including age,body weight,defect area,gender,risk adjustment in congenital heart surgery-1(RACHS-1)score,diagnosis type.The correlation between maximum vasoactive inotropic score(VIS)and vitamin D level were analyzed at 24 h after surgery.According to the vitamin D level at T3,these neonates were divided into deficient group,insufficient group and normal group.The 24-hour pleural fluid volume,24-hour urine volume,mechanical ventilation time,length of hospital stay in ICU,and incidence of adverse events,prognosis were compared among three groups.Results The 25-(OH)D levels of neonates with critical CHD were lower at T2 and T3 than those at T1,while the degree of vitamin D deficiency was higher than that at T1(P<0.05).At T1,there was no significant differences in age,body weight,defect area,gender,RACHS-1 score and diagnosis type among three groups(P>0.05).The maximum VIS score within 24 h after surgery was(31.75±3.28).Correlation analysis revealed that 25-(OH)D levels at T2 and T3 were negatively correlated with the maximum VIS score within 24 hours(r=-0.615,-0.529,P<0.05),while the degree of vitamin D deficiency at T2 and T3 was positively correlated with the maximum VIS score within 24 hours(r=0.466,0.368,P<0.05).There was no statistically significant differences in the pleural fluid volume,urine volume,mechanical ventilation time and the incidence of adverse events among three groups(P>0.05).The length of hospital stay was the longest in deficient group(P<0.05).Conclusion The 25-(OH)D levels of neonates with critical CHD are decreased within 24 hours after surgery,which may be related to the increase in support rate of positive inotropic action.