Corral Luisa, Carrió María L, Ventura Josep L, Torrado Herminia, Javierre Casimiro, Rodriguez-Castro David, Farrero Elisabet, Valero José, Ortiz Daniel
Department of Intensive Care, Hospital Universitari de Bellvitge, Barcelona, Spain.
J Cardiothorac Vasc Anesth. 2009 Apr;23(2):166-9. doi: 10.1053/j.jvca.2008.11.014. Epub 2009 Feb 7.
The purpose of this study was to determine the possible correlation between inflammatory activation after cardiac surgery with cardiopulmonary bypass, measured by postoperative C-reactive protein concentrations, and immediate intensive care unit outcome.
A prospective, clinical cohort study.
A 10-bed surgical intensive care unit at a tertiary university hospital.
Two hundred sixteen consecutive patients undergoing nonemergency cardiac surgery with cardiopulmonary bypass.
Parsonnet and Acute Physiology and Chronic Health Evaluation scores, characteristics of the surgical intervention, intensive care unit length of stay, and mortality were recorded along with the following variables: cardiac (hours requiring inotropic support and new atrial fibrillation), respiratory (oxygenation index and hours requiring intubation), renal (difference between serum creatinine at admission and maximum creatinine), and analytic (C-reactive protein at admission and 6, 24, and 48 hours later; troponin I; CK-MB; and lactate).
Postoperative C-reactive protein concentrations did not correlate with variables such as time requiring inotropic support or intubation, oxygenation index, delta serum creatinine, and intensive care unit length of stay (with the exception of cardiopulmonary bypass time and the more frequent norepinephrine requirement in patients with higher C-reactive protein concentration at 48 hours); nor did C-reactive protein correlate with the analytic variables (with the exception of the lactate peak and C-reactive protein concentrations at 24 and 48 hours). There was no correlation between C-reactive protein and postoperative variables for coronary artery bypass graft surgery and valvular groups analyzed separately.
Postoperative C-reactive protein does not seem to be a useful marker in predicting outcome after 48 hours in the intensive care unit.
本研究旨在确定通过术后C反应蛋白浓度测量的体外循环心脏手术后炎症激活与重症监护病房即刻结局之间的可能相关性。
一项前瞻性临床队列研究。
一所三级大学医院的拥有10张床位的外科重症监护病房。
216例连续接受非急诊体外循环心脏手术的患者。
记录Parsonnet评分、急性生理与慢性健康状况评估（APACHE）评分、手术干预特征、重症监护病房住院时间和死亡率，以及以下变量：心脏相关变量（需要血管活性药物支持的时间和新发房颤）、呼吸相关变量（氧合指数和需要插管的时间）、肾脏相关变量（入院时血清肌酐与最高肌酐之间的差值）和分析指标（入院时、6小时、24小时和48小时后的C反应蛋白；肌钙蛋白I；肌酸激酶同工酶；以及乳酸）。
术后C反应蛋白浓度与诸如需要血管活性药物支持或插管的时间、氧合指数、血清肌酐差值和重症监护病房住院时间等变量无相关性（48小时时C反应蛋白浓度较高的患者体外循环时间和去甲肾上腺素使用更频繁除外）；C反应蛋白与分析指标也无相关性（24小时和48小时时乳酸峰值和C反应蛋白浓度除外）。分别分析冠状动脉搭桥手术组和瓣膜手术组时，C反应蛋白与术后变量之间无相关性。
术后C反应蛋白似乎并非预测重症监护病房48小时后结局的有用指标。
