【原】心脏手术患儿术后血浆肌钙蛋白变化趋势

罂粟花anesthGH 2021-07-21

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Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery

背景与目的

推测儿童心脏手术后肌钙蛋白-I水平升高这个特定模式的预后意义。对幼儿心脏手术后肌钙蛋白-I水平缺乏特意数据，我们假设TN-I的升高随手术类型的不同而不同，持续的升高预示着预后不良。

方法

我们对90名年龄小于一岁的心脏手术患儿的TN-I水平(术前、4、8、12、24、术后48小时)进行了预测:非体外循环 (CPB)下(n = 15),体外循环下(n = 43),和体外循环(CPB)下心室切开 (n = 32)。

结果

所有患者均有未检测到的TN-I水平基线。在48小时内TN-I水平曲线下面积(AUC)在手术组间有显著差异(p < 0.002)，CPB下心室切口组最高。一般来说，TN-I水平在术后4小时达到峰值，并在48小时内恢复到接近正常水平。

结论

术后持续TN-I升高超过8小时是术后低心排和死亡率的一个强有力的预测指标(定义为灌注不足最终导致内脏器官损伤，OR21.5; p = 0.001) (有30%患者TN-I持续升高，而其余患者中只有3.5%)，患者年龄、解剖/手术复杂性、术后支持水平是独立因素。

原始文献摘要

Abstract

Objective:

Troponin-I (TN-I) levels are elevated following pediatric cardiac surgery with speculation that particular patterns may have prognostic significance. There is lack of procedure-specific data regarding postoperative TN-I levels in infants undergoing cardiac surgery. We hypothesized that TN-I elevation varies with type of surgery and persistent elevation predicts poor prognosis.

Methods: We prospectively measured serial TN-I levels (preoperatively, 4, 8, 12, 24, and 48 hours postoperatively) in 90 infants (age < 1 year) undergoing cardiac surgery: off cardiopulmonary bypass (CPB) (n = 15), on CPB (n = 43), and on CPB with ventricular incision (CPB with ventricular incision) (n = 32).

Results:

All patients had undetectable baseline TN-I levels. The area under the curve (AUC) of TN-I levels over the 48-hour period was significantly different among the surgical groups (p < 0.002), and highest in patients with CPB with ventricular incision. Generally, TN-I levels peaked by 4 hours after surgery and returned to near-normal levels within 48 hours. A persistent TN-I rise beyond 8 hours after surgery was a strong predictor of postoperative hypoperfusion injury (defined as a composite endpoint of endorgan injury resulting from inadequate perfusion, OR 21.5; p = 0.001) and mortality (30% in those with persistently high TN-I, compared with 3.5% in the remaining patients; p < 0.001), independent of patient age, anatomy/complexity of surgery, and level of postoperative support.

Conclusions:

Our data provide benchmark values for TN-I levels following cardiac surgery in infants. Extent of TN-I elevation correlates with type of surgery. Persistent TN-I elevation beyond 8 hours after surgery is strongly associated with postoperative hypoperfusion injury and mortality.

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