岭南现代临床外科2025，Vol.25Issue(6)：388-394,7.DOI:10.3969/j.issn.1009-976X.2025.06.007
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
Clinical characteristics of excessive release of cytokines in patients undergoing extracorporeal circulation surgery in cardiovascular surgery
摘要
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 proce-dure,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 associa-tion 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 exacer-bated 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 under-going long-term dialysis,and elderly patients.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Key words
cardiopulmonary bypass/systemic inflammatory response syndrome/acute respiratory distress syndrome/cytokine release syndrome/clinical features分类
医药卫生引用本文复制引用
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(6):388-394,7.基金项目
国家自然科学基金项目(82271806) （82271806）
中山大学孙逸仙纪念医院逸仙启航项目(YXQH202430) （YXQH202430）
