摘要
目的评估B型钠尿肽(B-type natriuretic peptide,BNP)、肌钙蛋白I(cardiac troponin I,cTn-I)和中心静脉氧饱和度(central venose oxygen saturation,ScvO2)在预测体外循环下(cardiopulmonary bypass,CPB)儿童先心病矫治术低心排血量综合征(low cardiac output syndrome,LCOS)的价值。方法选取2017年4月至2018年3月70例接受CPB下先心病矫治术的患儿(5天至160个月)进行前瞻性观察性研究。根据患儿是否出现LCOS进行分类。分别于CPB后2、12、24、48 h测定上述生物标志物水平。采用logistic多元回归模型对临床资料和测量结果进行分析。结果22例(31.4%)出现LCOS(组1),48例(68.6%)无LCOS(组2)。CPB后2 h cTn-I水平>13 ng/ml(OR=40.2,95%CI:9.4~171.4,P<0.001),CPB后12 h ScvO2水平<0.37(OR=124.7,95%CI:28.7~538.2,P<0.001)为LCOS的独立预测因子。结论CPB术后12 h的ScvO2及2 h cTn-I水平是LCOS的早期独立预测因子。cTn-I与ScvO2在CPB后12 h联合使用使预测小儿心脏矫治术后LCOS的能力增强。
Objective To assess the predictive value of atrial natriuretic peptide,b-type natriuretic peptide(BNP),cardiac troponin I(cTn-I)and central venose oxygen saturation(ScvO2)as indicators of low cardiac output syndrome(LCOS)in children with congenital heart disease undergoing cardiopulmonary bypass(CPB).Methods After corrective surgery for congenital heart disease under CPB,70 children(aged 5 days to 160 months)were enrolled in a prospective observational pilot study during 1-year period from April 2017 to March 2018.The patients were classified according to whether they developed low cardiac output syndrome.Biomarker levels were measured at 2,12,24,and 48 h post-CPB.The clinical data and outcome variables were analyzed by a multiple logistic regression model.Results Twenty-two(31.4%)patients developed low cardiac output syndrome(group 1)and the remaining 48(68.6%)patients were included in group 2.cTn-I levels>13 ng/ml at 2 hours after CPB(OR=40.2,95%CI:9.4-171.4,P<0.001)and ScvO2 levels<0.37 at 12 hours following CPB(OR=124.7,95%CI:28.7-538.2,P<0.001)were independent predictors of low cardiac output syndrome.Conclusion Our results suggest that cTn-I at 2 h and ScvO2 levels at 12 h post-CPB are evident early predictors of low cardiac output syndrome.This predictive capacity is,moreover,reinforced when cTn-I combined with ScvO2 following CPB.These 2 cardiac biomarkers would aid in therapeutic decision-making in clinical practice and would also enable clinicians to modify the type of support to be used in the pediatric intensive care unit.
作者
戴巍
戴华
李珊珊
徐怡
骆德强
Dai Wei;Dai Hua;Li Shanshan;Xu Yi;Luo Deqiang(Department of Intensive Care Unit,the First Affiliated Hospital of Nanchang University,Nanchang 330000,China;Department of Intensive Care Unit,the Fifth People's Hospital of Shangrao City,Shangrao 334000,China;Department of Intensive Care Unit,Wuhan Asia Heart Hospital,Wuhan 430074,China;Department of Head and Neck Radiotherapy,Jiangxi Cancer Hospital,Nanchang 330000,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2020年第6期330-335,共6页
Chinese Journal of Thoracic and Cardiovascular Surgery
