围手术期羟氯喹的应用对系统性红斑狼疮患者心脏术后的影响

Effect of perioperative hydroxychloroquine on cardiac surgery in patients with systemic lupus erythematosus

目的评估围手术期羟氯喹的应用对行心脏外科手术系统性红斑狼疮(SLE)患者预后的影响。方法将郑州大学第一附属医院心血管外科2010年1月至2021年6月期间所有行心脏外科手术且术前服用羟氯喹和糖皮质激素≥7天的SLE患者纳入观察组(28例),男3例,女25例;年龄(38.3±8.2)岁。选取术前未使用羟氯喹,仅使用糖皮质激素的患者纳入对照组(24例),男2例,女22例;年龄(37.9±9.8)岁。比较两组患者术后并发症及生存情况。结果与对照组相比,观察组术后急性肾功能不全和术后新发肺炎发生率较低(P<0.05),术后抗生素使用时长、术后ICU滞留、术后住院时长和住院总费用均明显少于对照组,差异有统计学意义(P<0.05)。观察组患者住院期间病死率低于对照组,观察组患者6个月生存率和1年生存率高于对照组,但差异无统计学意义(P>0.05)。结论围手术期应用羟氯喹可明显降低术后急性肾功能不全和肺炎发生率,减少术后抗生素使用时长、术后ICU滞留和术后住院时长,降低住院费用。羟氯喹可能降低SLE患者心脏外科住院期间病死率,提高术后远期生存率,但仍需长期大样本的临床研究。

Objective To evaluate the effect of perioperative application of hydroxychloroquine on the prognosis of patients undergoing cardiac surgery.Methods All SLE patients in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Zhengzhou University who took hydroxychloroquine and glucocorticoid for more than 7 days before operation were enrolled in the observation group(28 cases),including 3 males and 25 females,aged(38.3±8.2)years old.Patients who did not use hydroxychloroquine but only used glucocorticoid before operation were included in the control group(24 cases),including 2 males and 22 females,aged(37.9±9.8)years old.There was no significant difference in preoperative clinical data between the two groups in terms of sex,age,BMI,course of systemic lupus erythematosus,hemoglobin,albumin,C-reactive protein,ALT,serum creatinine,ejection fraction,diabetes,hypertension,hyperlipidemia,smoking,alcoholism,preoperative atrial arrhythmia,ventricular arrhythmia,atrioventricular block and so on.The constituent ratio of preoperative operation plan was basically the same between the two groups.The postoperative complications and survival of the two groups were compared.Results There was no significant difference in early clinical indexes between the two groups,such as cardiopulmonary bypass time(t=0.12,P=0.19),chest drainage volume(t=0.30,P=0.77),second thoracotomy hemostasis(χ^(2)=1.17,P=0.46).There was no significant difference in drug-related complications such as new retinopathy,myocardial concentric hypertrophy,atrial arrhythmia(χ^(2)=1.27,P=0.26),ventricular arrhythmia(χ^(2)=0.98,P=0.32),atrioventricular block(χ^(2)=0.06,P=0.82)and other drug-related complications between the observation group and the control group.There was no significant difference between the two groups in postoperative acute heart failure(χ^(2)=1.17,P=0.28),acute liver insufficiency(χ^(2)=1.17,P=0.28),sternal infection and IABP use(χ^(2)=0.47,P=0.50).Compared with the control group,the incidence of acute renal insufficiency after operation was lower in the observation group(χ^(2)=4.51,P=0.04).The incidence of new postoperative pneumonia was lower(χ^(2)=8.26,P=0.01).The length of postoperative antibiotic use,the length of postoperative ICU hospital stay,the postoperative hospital stay and the total cost of hospitalization in the observation group were significantly less than those in the control group(z=2.71,2.09,2.02,2.02,P=0.01,0.04,0.04,0.04).Compared with the control group,the in-hospital mortality rate of patients in the observation group was lower than that in the control group(3.6%vs.12.5%,χ^(2)=0.47,P=0.50),and the 6-month and 1-year survival rates of the observation group were higher than those of the control group(92.9%vs.83.3%,92.9%vs.79.2%;χ^(2)=0.41,2.17;P=0.53,0.34),but the difference was not statistically significant.Conclusion Perioperative administration of hydroxychloroquine can significantly reduce the incidence of postoperative acute renal insufficiency and pneumonia,reduce the duration of postoperative antibiotic use,postoperative ICU hospital stay,postoperative hospital stay,and the cost of hospitalization.Hydroxychloroquine may reduce the in-hospital mortality and improve the long-term survival rate after cardiac surgery,but long-term large sample clinical studies are still needed.