先天性心脏病患儿术后血淀粉酶升高峰值延迟的影响因素

Influencing factors of delayed peak blood amylase elevation in children with congenital heart disease post-operation

目的先天性心脏病患儿术后血淀粉酶升高在既往已有研究报道。对于血淀粉酶变化趋势的规律研究较少。本研究旨在探索先天性心脏病术后患儿血淀粉酶变化趋势及对于血淀粉酶升高峰值延迟原因的探索。方法本研究为一项回顾性研究。连续入组阜外医院2019年1月1日至2019年12月31日先天性心脏病术后(1个月至6岁)血淀粉酶升高大于正常值3倍以上的180名患儿。按照血淀粉是否在48 h内达峰值,分为两组,正常达峰组和延迟达峰组,比较两组在人口学基本特征、体外循环时间、先天性心脏病种类、手术方式、重症监护时间及有创呼吸机时间等的差别。探索血淀粉酶高峰延迟的影响因素。对于血淀粉酶峰值延后的因素探索采用logistic回归。结果血淀粉酶在两组患儿性别、年龄、体质量指数等人口基本学特征、阻断时间、谷丙转氨酶、甘油三酯、肌酸激酶、乳酸最高值水平、淀粉酶最高值水平、呼吸机时间上无统计学差异。淀粉酶峰值在术后48 h后出现组右心病变的比例较高(P<0.01),有更长的转机时间(P<0.01),相对更长的ICU时间(P<0.01)。右心病变为术后淀粉酶峰值延迟的独立危险因素。结论右心病变是血淀粉酶术后48 h仍处于上升趋势的独立危险因素。

AIM Hyperamylasemia after congenital heart disease surgery in children and infants has been reported for many years. Only a few study aimed to explore the trend of blood amylase of these children. Our research is to explore the influencing factors of delayed peak blood amylase elevation in children after congenital heart disease post-operation. METHODS This is a retrospective study. 180 children were included with 3 times higher blood amylase after congenital heart disease from January 1 to December 31 of 2019 in Fuwai hospital undergoing repair of congenital heart disease. They were divided to 2 groups according to whether blood amylase reach to peak in 48 hours after surgery. To identify the risk factor of delayed peak blood amylase, a logistic regression was used. RESULTS Overall, there are no significance statistical difference in basic demographic characteristics, CPB(Cardiopulmonary bypass), ACC(aortic cross clamp) and other biochemical indicators. The patients with delayed peak blood have longer CPB time, ICU time and were more likely right heart disease. The logistic regression analysis suggests right heart disease was an independent risk factor of delayed peak blood amylase(P = 0.002;Odds Ratio OR 5.205, 95% Confidence Interval CI 1.801 –15.047). CONCLUSION The right heart disease was an independent risk factor of delayed peak blood amylase in children after repair of congenital heart disease.