心脏手术前血浆谷氨酰胺水平与术后感染有关；一项观察性研究。
Plasma glutamine levels before cardiac surgery are related to post-surgery infections; an observational study.
作者信息
Buter Hanneke, Koopmans Matty, Kemperman Ramses, Jekel Lilian, Boerma Christiaan
机构信息
Departments of Intensive Care, Medical Centre Leeuwarden, Henri Dunantweg 2, 8935 AD, Leeuwarden, The Netherlands.
Clinical Chemistry, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
出版信息
J Cardiothorac Surg. 2016 Nov 25;11(1):155. doi: 10.1186/s13019-016-0549-1.
BACKGROUND
A low plasma glutamine level was found in 34% of patients after elective cardiothoracic surgery. This could be a result of the inflammation caused by surgical stress or the use of extracorporeal circulation (ECC). But it is also possible that plasma glutamine levels were already lowered before surgery and reflect an impaired metabolic state and a higher likelihood to develop complications. In the present study plasma glutamine levels were measured before and after cardiac surgery and we questioned whether there is a relation between plasma glutamine levels and duration of ECC and the occurrence of postoperative infections.
METHODS
We performed a single-centre prospective, observational study in a closed-format, 20-bed, mixed ICU in a tertiary teaching hospital. We included consecutive patients after elective cardiac surgery with use of extracorporeal circulation. Blood samples were collected on the day prior to surgery and at admission on the ICU. The study was approved by the local Medical Ethics Committee (Regional Review Committee Patient-related Research, Medical Centre Leeuwarden, nWMO 115, April 28th 2015).
RESULTS
Ninety patients were included. Pre-operative plasma glutamine level was 0.42 ± 0.10 mmol/l and post-operative 0.38 ± 0.09 mmol/l (p < 0.001). There was no relation between duration of extracorporeal circulation or aortic occlusion time and changes in plasma glutamine levels. A logistic regression analysis showed a significant correlation between the presence of a positive culture during the post-operative course and pre-operative plasma glutamine levels (p = 0.04).
CONCLUSION
Plasma glutamine levels are significantly lower just after cardiac surgery compared to pre-operative levels. We did not find a relation between the decrease in plasma glutamine levels and the duration of extracorporeal circulation or aortic clamp time. There was a correlation between pre-operative plasma glutamine levels and the presence of a positive culture after cardiac surgery.
TRIAL REGISTRATION
ClinicalTrials.gov, number NCT02444780 .
背景
在择期心胸外科手术后，34%的患者血浆谷氨酰胺水平较低。这可能是手术应激或体外循环（ECC）使用引起的炎症所致。但也有可能血浆谷氨酰胺水平在手术前就已降低，反映出代谢状态受损以及发生并发症的可能性更高。在本研究中，我们测量了心脏手术后血浆谷氨酰胺水平，并探讨血浆谷氨酰胺水平与体外循环时间及术后感染发生率之间是否存在关联。
方法
我们在一家三级教学医院的封闭式20张床位的混合重症监护病房进行了一项单中心前瞻性观察研究。纳入接受体外循环择期心脏手术的连续患者。在手术前一天和入住重症监护病房时采集血样。该研究获得当地医学伦理委员会批准（吕伐登医疗中心患者相关研究区域审查委员会，nWMO 115，2015年4月28日）。
结果
纳入90例患者。术前血浆谷氨酰胺水平为0.42±0.10 mmol/L，术后为0.38±0.09 mmol/L（p<0.001）。体外循环时间或主动脉阻断时间与血浆谷氨酰胺水平变化之间无关联。逻辑回归分析显示，术后病程中培养结果呈阳性与术前血浆谷氨酰胺水平之间存在显著相关性（p=0.04）。
结论
与术前水平相比，心脏手术后血浆谷氨酰胺水平显著降低。我们未发现血浆谷氨酰胺水平下降与体外循环时间或主动脉夹闭时间之间存在关联。术前血浆谷氨酰胺水平与心脏手术后培养结果呈阳性之间存在相关性。
试验注册
ClinicalTrials.gov，编号NCT02444780 。
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