心血管外科体外循环手术患者围术期体内细胞因子过度释放的临床特征分析

doi:10.3969/j.issn.1009-976X.2025.06.007

摘要/Abstract

摘要： 目的本研究旨在探讨持续性细胞因子过度释放对成人心脏手术后72 h及90 d预后的影响。方法回顾性分析2017年至2024年单中心连续收治的571例心脏大血管病患者,按细胞因子检验指标高低分为释放过度组（117例）和常规组（454例）。记录其体外循环术前、术后72 h内以及术后4~10 d手术相关指标及术后转归情况,比较分析两组患者心脏手术不良预后的相关指标及临床结局。结果共纳入571例心脏手术患者,其中释放过度组117例,常规组454例。基线资料显示,释放过度组高龄（≥75岁,P<0.0001）、肾功能不全（P<0.0001）及PCI手术史（P=0.0003）患者比例显著更高。术中分析发现,释放过度组ECMO支持率、David手术比例及心肺转流时间中位数（P<0.0001）均显著高于常规组。术后结局显示,释放过度组SIRS（校正OR=11.40,95%CI：4.14~31.39）、死亡（OR=23.45,95%CI：5.12~107.38）及术后透析（OR=11.21,95%CI：5.92~21.24）风险显著升高,且ICU住院时间延长11 h（23 h vs 12 h;风险比HR=0.34,95%CI：0.27~0.42）,总住院时间延长8 d（19 d vs 11 d;HR=0.52,95%CI：0.40~0.66）,提示炎症因子释放过度与不良预后密切关联。结论心脏外科体外循环患者围术期细胞因子过度释放会导致ICU住院时间以及总住院时间延长,导致术后谵妄发生率增加,并加重肾脏损害。手术中主动脉阻断时间长,输注大量血制品是细胞因子释放增多的重要危险因素。此外,术前存在慢性炎症状态,长期透析及高龄患者术后细胞因子水平升高更为显著。

关键词: 体外循环, 全身炎症反应综合征, 急性呼吸窘迫综合征, 细胞因子释放综合征, 临床特征

Abstract: Objective This study aimed to investigate the impact of persistent cytokine over-release on the 72-hour and 90-day prognosis after adult cardiac surgery. Methods A retrospective analysis was conducted on 571 consecutive patients with confirmed cardiovascular and great vessel diseases admitted to a single center between 2017 and 2024. Patients were divided into an over-release group （117 cases） based on high cytokine test indicators and a conventional group （454 cases） for the remaining patients. Surgical-related indicators before cardiopulmonary bypass, within 72 hours post-surgery, and 4~10 days post-surgery, as well as postoperative outcomes, were recorded. Related indicators of adverse prognosis and clinical outcomes after cardiac surgery were compared and analyzed between the two groups. Results A total of 571 cardiac surgery patients were included in the study, with 117 patients in the over-release group and 454 in the conventional group. Baseline data showed a significantly higher proportion of advanced age （≥75 years, P<0.0001）, renal insufficiency （P<0.0001）, and history of PCI （P=0.0003） in the over-release group. Intraoperative analysis revealed that the rates of ECMO support, David procedure, and median cardiopulmonary bypass time （P<0.0001） were significantly higher in the over-release group compared to the conventional group. Postoperative outcomes indicated a significantly increased risk of SIRS （adjusted OR=11.40, 95%CI： 4.14~31.39）, mortality （OR=23.45, 95%CI： 5.12~107.38）, and postoperative dialysis （OR=11.21, 95%CI： 5.92~21.24） in the over-release group. Furthermore, ICU length of stay was prolonged by 11 hours （23 h vs 12 h; HR=0.34, 95%CI： 0.27~0.42）, and total length of stay was prolonged by 8 days （19 d vs 11 d; HR=0.52, 95%CI： 0.40~0.66）, suggesting a close association between excessive inflammatory cytokine release and adverse prognosis. Conclusion Perioperative cytokine over-release in cardiac surgery patients undergoing cardiopulmonary bypass leads to increased ICU length of stay and total length of stay, an increased incidence of postoperative delirium, and exacerbated renal damage. Long aortic clamping time and massive transfusion of blood products during surgery are important risk factors for increased cytokine release. Additionally, elevated postoperative cytokine levels were more pronounced in patients with pre-existing chronic inflammatory conditions, those undergoing long-term dialysis, and elderly patients.

Key words: cardiopulmonary bypass, systemic inflammatory response syndrome, acute respiratory distress syndrome, cytokine release syndrome, clinical features

中图分类号:

R654.2

李婧雯, 傅媛, 马天较, 曾昭培, 李凌, 郑俊猛. 心血管外科体外循环手术患者围术期体内细胞因子过度释放的临床特征分析[J]. 岭南现代临床外科, 2025, 25(06): 388-394.

LI Jing-wen, FU Yuan, MA Tian-jiao, ZENG Zhao-pei, LI Ling, ZHENG Jun-meng. Clinical characteristics of excessive release of cytokines in patients undergoing extracorporeal circulation surgery in cardiovascular surgery[J]. Lingnan Modern Clinics In Surgery, 2025, 25(06): 388-394.

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