Giordano Raffaele, Cantinotti Massimiliano, Arcieri Luigi, Poli Vincenzo, Pak Vitali, Murzi Bruno
Pediatric Cardiac Surgery Unit, Heart Hospital, Tuscany Foundation CNR "G. Monasterio", Massa, Italy.
Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples "Federico II", Naples, Italy.
Pediatr Cardiol. 2017 Jun;38(5):1071-1076. doi: 10.1007/s00246-017-1621-x. Epub 2017 May 8.
The aims of our study were to describe plasma brain natriuretic peptide (BNP), Troponin I (TnI), and Cystatin C (Cys-C) concentration kinetics in the postoperative period after arterial switch operation in neonate, and to test the correlation between the plasma biomarkers and early clinical outcomes. We prospectively enrolled 29 neonates who underwent ASO. All patients received Custodiol cardioplegia. Blood samples were collected preoperatively (one day before) and in the ICU immediately after admission, and then 6, 12, 24, and 48 h after surgery. TnI peak (mean 17.23 ± 7.0 ng/mL) occurred between the arrival in the ICU and the 6th hour, then we had a constant decrease. TnI had a good correlation with the inotropic support time (r = 0.560, p = 0.0015) and ICU time (r = 0.407, p = 0.028), less than with ventilation and Hospital stay (r = 0.37, p = 0.0451 and r = 0.385, p = 0.0404). BNP peak (mean 4773.79 ± 2724.52 ng/L) was in the preoperative time with a constant decrease after the operation and it had no significant correlations with clinical outcomes. The CyS-C had the highest preoperative values, which decreased during the operating phase, and then constantly increased upon arrival to the ICU with a peak at 48 h (mean 1.76 ± 0.35 mg/L). CyS-C peak had a good correlation with a plasmatic creatinine peak (r = 0.579, p = 0.0009) but not with other clinical outcomes. Our study demonstrated significant correlations between the Tnl peak and early clinical outcomes in neonates undergoing arterial switch operation. Other plasma biomarkers such as the BNP and CyS-C had no direct correlation.
我们研究的目的是描述新生儿动脉调转手术后血浆脑钠肽（BNP）、肌钙蛋白I（TnI）和胱抑素C（Cys-C）浓度的动力学变化，并检测血浆生物标志物与早期临床结局之间的相关性。我们前瞻性纳入了29例接受动脉调转手术（ASO）的新生儿。所有患者均接受了冷晶体停搏液。术前（手术前一天）、入住重症监护病房（ICU）后即刻以及术后6、12、24和48小时采集血样。TnI峰值（平均17.23±7.0 ng/mL）出现在进入ICU至第6小时之间，随后持续下降。TnI与正性肌力药物支持时间（r = 0.560，p = 0.0015）和ICU停留时间（r = 0.407，p = 0.028）有良好的相关性，与通气时间和住院时间的相关性较差（r = 0.37，p = 0.0451和r = 0.385，p = 0.0404）。BNP峰值（平均4773.79±2724.52 ng/L）出现在术前，术后持续下降，且与临床结局无显著相关性。Cys-C术前值最高，在手术阶段下降，进入ICU后持续升高，在48小时达到峰值（平均1.76±0.35 mg/L）。Cys-C峰值与血浆肌酐峰值有良好的相关性（r = 0.579，p = 0.0009），但与其他临床结局无相关性。我们的研究表明，接受动脉调转手术的新生儿TnI峰值与早期临床结局之间存在显著相关性。其他血浆生物标志物如BNP和Cys-C无直接相关性。
