摘要
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.
作者
陈仁伟
艾力夏提·阿里甫
王海凡
王娜
张瑞
贾兵
CHEN Renwei;Alifu·Ailixiati;WANG Haifan;WANG Na;ZHANG Rui;JIA Bing(The department of Cardiothoracic surgery in children,Hainan Women and Children's Medical Center&the Affiliated maternal and Child Health Hospital of Hainan Medical university&Children's Hospital,Haikou 570300,Hainan,China;Department of Cardiothoracic Surgery,Children's Hospital of Fudan University,Shanghai 201102,China)
出处
《贵州医科大学学报》
CAS
2021年第7期824-828,833,共6页
Journal of Guizhou Medical University
基金
海南省卫生健康行业科研项目(20A200158)。
关键词
婴儿
新生
预后
危重先天性心脏病
手术
血清25-羟基维生素D
infant,newborn
critical congenital heart disease
surgery
serum 25-hydroxyvitamin D[25-(OH)D]
prognosis