Herline A J, Pinson C W, Wright J K, Debelak J, Shyr Y, Harley D, Merrill W, Starkey T, Pierson R, Chapman W C
Department of Surgery, Vanderbilt University Medical Center and St. Thomas Hospital, Nashville, Tennessee 37232-4753, USA.
Am Surg. 1999 Sep;65(9):819-25; discussion 826.
Previous series have identified an increased risk of developing acute postoperative pancreatitis in heart transplant recipients and other cardiac surgical patients, and some suggest that mortality is significantly increased when pancreatitis occurs in the transplant setting. We conducted a retrospective case-control analysis of adult patients undergoing orthotopic heart transplant or other cardiac procedures from April 1985 through June 1996 at our medical center. Specific risk factors for outcome were assessed including low cardiac output, intra-aortic balloon pump usage, exogenous calcium repletion, immunosuppression, cytomegalovirus infection, cholelithiasis, prior pancreatitis, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. There was a 30-fold increase in the incidence of pancreatitis in the heart transplant group [12 of 394 (3%) vs 27 of 24,237 (0.1%); P < 0.01]. Compared with the nontransplant cardiopulmonary bypass patients, the transplant patients experienced a statistically significant increased incidence of immunosuppression and three or more risk factors. Transplant patients with pancreatitis demonstrated a significant increase in APACHE II scores and the incidence of three or more risk factors compared with their transplant control group. Patients undergoing nontransplant cardiac procedures and developing pancreatitis had significantly increased cross-clamp times, incidence of low cardiac output, APACHE II scores, and incidence of three or more risk factors compared with their nontransplant cohort. In conclusion, there is a significant increase in the incidence of pancreatitis after orthotopic heart transplant compared with other cardiac procedures. Analysis demonstrates the additive effect of multiple individual risk factors. Immunosuppression confers significant additional risk for pancreatitis in the orthotopic heart transplant patient.
以往的系列研究已确定心脏移植受者和其他心脏手术患者发生急性术后胰腺炎的风险增加，并且一些研究表明，在移植情况下发生胰腺炎时死亡率会显著增加。我们对1985年4月至1996年6月在我们医疗中心接受原位心脏移植或其他心脏手术的成年患者进行了一项回顾性病例对照分析。评估了结局的特定风险因素，包括低心输出量、主动脉内球囊泵的使用、外源性钙补充、免疫抑制、巨细胞病毒感染、胆石症、既往胰腺炎以及急性生理与慢性健康状况评估（APACHE）II评分。心脏移植组胰腺炎的发病率增加了30倍[394例中有12例（3%），而24237例中有27例（0.1%）；P<0.01]。与非移植体外循环患者相比，移植患者免疫抑制和三种或更多风险因素的发生率在统计学上显著增加。与移植对照组相比，发生胰腺炎的移植患者APACHE II评分和三种或更多风险因素的发生率显著增加。与非移植队列相比，接受非移植心脏手术并发生胰腺炎的患者交叉夹闭时间、低心输出量发生率、APACHE II评分以及三种或更多风险因素的发生率显著增加。总之，与其他心脏手术相比，原位心脏移植后胰腺炎的发病率显著增加。分析表明多个个体风险因素具有累加效应。免疫抑制使原位心脏移植患者发生胰腺炎的额外风险显著增加。
