Dhillon Santokh, Yu Xiaoyang, Cheypesh Andriy, Ross David B, Li Jia
Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
Division of Cardiac Surgery, Department of Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
Congenit Heart Dis. 2015 May-Jun;10(3):226-33. doi: 10.1111/chd.12195. Epub 2014 Jun 17.
Serum C-reactive protein (CRP) is a marker of systemic inflammatory response induced by cardiopulmonary bypass (CPB). Neonates undergoing the Norwood procedure (NP) have a poorer systemic oxygen transport status than those after other CPB surgeries. We compared the perioperative CRP in neonates undergoing NP or arterial switch operation (ASO).
Data obtained prior to and within postoperative day (POD) 15 from 64 neonates in NP group and 47 in ASO group. Plasma CRP, white blood cells, doses of inotropes and steroid, cultures of blood and body fluids were recorded simultaneously. Demographic data included the durations of CPB, aortic cross clamp (ACC) and circulatory arrest, intensive care unit and hospital stay, and death.
NP group had a shorter CPB and ACC but a longer circulatory arrest than ASO group. CRP was higher preoperatively in NP group than ASO group (21 ± 24 vs.13 ± 26 mg/L, P = 0.01). CRP increased to 80 ± 48 mg/L after NP and 73 ± 36 mg/L after ASO on POD1-2, and then gradually decreased to 51 ± 35 mg/L in NP group and to 43 ± 46 mg/L in ASO group by POD-15. Throughout the postoperative period, CRP, as well as lactate, was significantly higher in NP group than ASO group (P = 0.04 and 0.003, respectively). CRP correlated positively with neutrophil count and negatively with lymphocyte count, CPB duration, and doses of hydrocortisone.
Neonates undergoing NP have a higher level of serum CRP, reflecting a greater systemic inflammatory response before and after CPB than those undergoing ASO, despite of shorter CPB and ACC. The higher level of serum CRP was associated with a significantly higher level of arterial lactate in the NP group than in the ASO group. This may suggest an important role of systemic oxygen transport in systemic inflammatory response in addition to CPB in neonates with congenital heart defects.
血清C反应蛋白（CRP）是体外循环（CPB）诱导的全身炎症反应的标志物。接受诺伍德手术（NP）的新生儿比接受其他CPB手术的新生儿具有更差的全身氧运输状态。我们比较了接受NP或动脉调转术（ASO）的新生儿围手术期的CRP。
收集64例NP组新生儿和47例ASO组新生儿术前及术后第15天内的数据。同时记录血浆CRP、白细胞、血管活性药物和类固醇剂量、血液和体液培养结果。人口统计学数据包括CPB、主动脉交叉钳夹（ACC）和循环停止时间、重症监护病房和住院时间以及死亡情况。
NP组的CPB和ACC时间比ASO组短，但循环停止时间比ASO组长。NP组术前CRP高于ASO组（21±24 vs.13±26 mg/L，P = 0.01）。术后第1 - 2天，NP组CRP升至80±48 mg/L，ASO组升至73±36 mg/L，然后在术后第15天，NP组逐渐降至51±35 mg/L，ASO组降至43±46 mg/L。在整个术后期间，NP组的CRP以及乳酸水平均显著高于ASO组（分别为P = 0.04和0.003）。CRP与中性粒细胞计数呈正相关，与淋巴细胞计数、CPB持续时间和氢化可的松剂量呈负相关。
接受NP的新生儿血清CRP水平较高，这反映出与接受ASO的新生儿相比，他们在CPB前后的全身炎症反应更强烈，尽管CPB和ACC时间较短。NP组血清CRP水平较高与动脉血乳酸水平显著高于ASO组有关。这可能表明在先天性心脏病新生儿中，除了CPB外，全身氧运输在全身炎症反应中起重要作用。
