体外循环心脏术后高淀粉酶血症对预后的影响-内科急危重症杂志.doc

体外循环心脏术后高淀粉酶血症对预后的影响 武汉亚洲心脏病医院ICU 李颖 刘彬 黄园琴 　　 摘 要目的：分析体外循环心脏术后患者发生高淀粉酶血症对预后的影响。方法：选择2012年8月至2013年1月我院在全麻体外循环下行心脏手术的成人患者100例，排除术前有胰腺病变、胆石症病史患者。于入ICU即刻、术后24h、48h、72h抽取外周静脉血2m1注入不抗凝试管，分离血清后用Somog-yi法测定血淀粉酶。同时监测白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原（PCT）。记录患者有无糖尿病病史、酗酒史、术中低血压、术后低心排。比较血淀粉酶变化与WBC、CRP、PCT等炎性指标之间的相关性。根据血淀粉酶测定结果将患者分为高淀粉酶血症组（血淀粉酶≥500u/dl）、轻度增高组（150≤血淀粉酶500u/dl）、正常组（血淀粉酶150u/dl）。比较三组间肾功能不全、肝功能不全、胃肠功能不全、院内感染、多器官功能障碍综合征（MODS）的发生率、机械通气时间、ICU留治时间、住院时间、院内死亡率。比较三组间糖尿病病史、酗酒史、术中低血压、术后低心排的发生率。结果 ：体外循环心脏手术患者血淀粉酶变化与WBC、CRP 呈正相关性，与PCT无直线关系；血淀粉酶轻度增高组肾功能不全，血淀粉酶增高组肾功能不全、院内感染、MODS的发生率均明显高于正常组，差异有显著性（P0.05）；血淀粉酶增高组ICU留治时间、院内死亡率明显高于正常组，差异有显著性（P0.05）；血淀粉酶增高组术中低血压、术后低心排的发生率均明显高于正常组，差异有显著性（P0.05）结论:体外循环心脏术后患者血淀粉酶水平与术后早期炎症反应有关。体外循环心脏手术患者发生高淀粉酶血症提示预后不佳。术中低血压、术后低心排可能是导致高淀粉酶血症的因素。 关键词 体外循环 高淀粉酶血症 多器官功能障碍综合征 死亡率 Effect of postoperative hyperamylasemia on prognosis of patients with cardiopulmonary bypass 【Abstract】 Objective To analyze effect of postoperative hyperamylasemia on prognosis of patients with cardiopulmonary bypass.Methods 100 postcardiac surgery patients with general anaesthesia and cardiopulmonary bypass during the study period of Augest 1st,2012 to January 31th,2013 at Wuhan Asia Heart Hospital were enrolled in the study. Patients with acute pancreatitis, a history of benign and malignant pancreatic diseases were excluded in this study.Two milliliter peripheral blood of the patients were collected into tube without heparin at the moment of entering ICU、24 hours 、48 hours、72hours after operation.The serum amylase measured by Somog-yi method.WBC、CRP、PCT were measured at the same time and the rectilinear correlation with them and serum amylase were studied.The patients were divided into three groups based on serum amylase level．The morbiditis of renal insufficiency、hepatic insufficiency、gastrointestinal function failure、infection in hospital、multiple organdys function syndrome，the time of mechanical ventilation，time of staying in ICU，mortality in hospital were compared.The dabet