婴儿心脏术后肌钙蛋白T水平对机械通气时间延长的影响

Effect of troponin T level on prolonged mechanical ventilation in infants after cardiac surgery

目的探讨肌钙蛋白T对婴儿心脏术后机械通气时间延长的影响。方法回顾性选取2019年1月至4月在南方医科大学附属广东省人民医院心外科行体外循环下心内直视术的192例先天性心脏病婴儿,按术后即刻肌钙蛋白T水平分为肌钙蛋白T高值组(3798.0~10000.0 ng/L)、中值组(1827.0~3709.0 ng/L)和低值组(316.2~1801.0 ng/L),各64例。低值组中,女28例,男36例,日龄203.00(129.75,274.50)d;中值组中,女30例,男34例,日龄118.00(76.50,173.75)d;高值组中,女24例,男40例,日龄168.50(78.00,219.25)d。采用方差分析、秩和检验、χ^(2)检验进行统计分析,通过单因素和多因素logistic回归模型分析术后肌钙蛋白T水平与术后机械通气时间延长的相关性,通过单因素和多因素线性回归模型分析术后肌钙蛋白T水平与重症监护停留时间及术后住院天数的相关性。结果术前日龄越小、手术体外循环时间越长、主动脉阻断时间越长,术后肌钙蛋白T水平越高(均P<0.05)。在校正了性别、日龄、胎龄、术前血红蛋白、术前血清肌酐、体外循环时间、主动脉阻断时间、先天性心脏病手术风险调整评分(RACHS-1)等因素后,多因素回归模型发现,肌钙蛋白T水平升高是机械通气时间延长的独立危险因素[OR=1.2(1.1,1.3),P<0.001]。结论肌钙蛋白T水平升高与婴儿先天性心脏病术后机械通气时间延长有关。

Objective To explore the effect of troponin T on prolonged mechanical ventilation in infants after cardiac surgery.Methods One hundred and ninety-two infants with congenital heart disease who underwent cardiac surgery under cardiopulmonary bypass in Department of Cardiac Surgery,Guangdong Provincial People's Hospital,Southern Medical University from January to April 2019 were retrospectively selected as the study objects.According to the immediate troponin T level after surgery,they were divided into a high-value group(3798.0-10000.0 ng/L),a middle-value group(1827.0-3709.0 ng/L),and a low-value group(316.2-1801.0 ng/L),with 64 cases in each group.There were 28 girls and 36 boys in the low-value group;they were 203.00(129.75,274.50)days old.There were 30 girls and 34 boys in the middle-value group;they were 118.00(16.50,173.75)days old.There were 24 girls and 40 boys in the high-value group;they were 168.50(78.00,219.25)days old.The analysis of variance,rank sum test,andχ^(2) test were used for the statistical analysis.The univariate and multivariate logistic regression models were used to analyze the correlation between postoperative troponin T level and prolonged mechanical ventilation.The univariate and multivariate linear regression models were used to analyze the correlation between postoperative troponin T level on one hand and length of stay in the intensive care unit and hospitalization time after the operation on the other hand.Results The younger the infants were and the longer the extracorporeal circulation during surgery and the aortic cross-clamp time were,the higher the postoperative troponin T level was(all P<0.05).After adjusting the gender,days,gestational age,preoperative hemoglobin,preoperative serum creatinine,cardiopulmonary bypass time,aortic cross-clamp time,and RACHS-1 score,the multivariate regression model found that the elevated troponin T level was an independent risk factor for prolonged mechanical ventilation[OR=1.2(1.1,1.3),P<0.001].Conclusion The elevation of troponin T level is associated with prolonged postoperative mechanical ventilation after congenital heart surgery in infants.