Objective To discuss the relationship between level changes of cholinesterase(ChE)and systemic inflammatory response syndrome(SIRS)after cardiopulmonary bypass(CPB),and study the predictive value of ChE to multiple organ dysfunction syndrome(MODS).Methods The patients received heart surgery under CPB were prospectively analyzed in the First Affiliated Hospital of Zhengzhou University from Feb.2021 to Dec.2022.The patients with SIRS were chosen into SIRS group(n=48)and patients withoutSIRS were chosen into control group(n=50).Data collection time was as follows:pre-operation(H0),4 hours(H4),8 hours(H8),12 hours(H12),24 hours(H24)and 48 hours(H48)after ICU admission.The activity of serum butyrylcholinesterase(BChE)was detected by using point-of-care testing(POCT)and corrected with hemoglobin(Hb).The correlation between BChE activity at time points of H24 and H48 and scores of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)was assessed.The predictive efficacy of BChE to MODS by using ROC curve analysis in SIRS patients after CPB.Results The prognosis was poorer,scores of APACHE Ⅱ and sequential organ failure assessment(SOFA)were higher(P＜0.05)at time points of H24 and H48,and ICU duration was longer(P=0.030)in SIRS group than those in control group.The activity of BChE decreased to the lowest value at time point of H12 in SIRS group and control group[1.16(0.73,1.47)×103 U/g Hb;0.82(0.71,1.0)×103 U/g Hb].The level of serum BChE was lower in SIRS group all the time than that in control group at time points from H8 to H48(P＜0.05).The results of Spearman correlation analysis showed that level of serum BChE at time point of H24 was negatively correlated to APACHE Ⅱ scores(r=-0.381,P=0.009)in SIRS group.In SIRS group,MODS occurred in 19 patients,and MODS occurred at time points from H24 to H48 in 15 patients.The level of serum BChE was lower all the time in MODS group than that in non-MODS group at time points from H8 to H48(P＜0.05).The results of ROC curve analysis,in prediction of MODS risk by using BChE at time points of H8 and H12,when H8 BChE ≤0.98 × 103 U/g Hb or H12≤0.76× 103 U/g Hb,MODSprogression risk significantly increased(AAUC=0.748,0.838).Conclusion The activity of serum BChE decreases significantly in SIRS patients after CPB,and early BChE depletion after CPB is closely related to the severity of SIRS and risk of MODS progression.
关键词
体外循环/胆碱酯酶/全身炎症反应综合征/多器官功能障碍综合征
Key words
Cardiopulmonary bypass/Cholinesterase/Systemic inflammatory response syndrome/Multiple organ dysfunction syndrome
万方数据