Zhang Hanwen,Qi Xinyu,Liu Haonan,et al.Changes and predictors for perioperative C-reactive protein in children with congenital scoliosis hemivertebral deformity[J].Journal of Clinical Pediatric Surgery,2024,(06):561-566.[doi:10.3760/cma.j.cn101785-202203078-010]
先天性脊柱侧凸半椎体畸形患儿围手术期血清C-反应蛋白变化及影响因素研究
- Title:
- Changes and predictors for perioperative C-reactive protein in children with congenital scoliosis hemivertebral deformity
- Keywords:
- Scoliosis; Congenital; Orthopedic Procedures; Perioperative Period; C-Reactive Protein; Root Cause Analysis
- 摘要:
- 目的 探讨儿童先天性脊柱侧凸半椎体畸形患儿围手术期血清C-反应蛋白的变化及影响因素。 方法 将2020年10月至2021年10月于首都医科大学附属北京儿童医院骨科接受手术治疗的101例先天性脊柱侧凸半椎体畸形患儿纳入研究,患儿均接受后路半椎体切除植骨融合内固定术。收集患儿一般情况、畸形程度、手术资料、实验室检查结果等,纳入多元线性回归方程,统计分析患儿围手术期血清C-反应蛋白(C-reactive protein,CRP)的变化及影响因素。 结果 101例患儿中,男43例,女58例,年龄(6.4±3.5)岁,均顺利完成手术,手术时间(199.2±68.4)min,平均手术节段3个,术前Cobb角(32.9±15.0)°,侧弯矫正率90.6%。术后第1天CRP(24.3±25.3)mg/L、第3天(52.0±35.6)mg/L。多元回归分析显示,年龄、术前Cobb角、手术时间、手术节段是术后CRP升高的独立预测因素。手术节段≥4个、手术时间≥157 min、术前Cobb角≥27°者血清CRP明显升高。 结论 先天性脊柱侧凸半椎体畸形患儿术后炎症和应激反应明显,血清CRP水平与畸形程度及手术创伤密切相关。脊柱畸形严重、手术节段多以及手术时间长的患儿术后CRP明显升高的风险较大。
- Abstract:
- Objective To explore the changes and predictors for perioperative C-reactive protein (CRP) in children with congenital scoliosis hemivertebral deformity and summarize the relevant clinical experiences.Methods From October 2020 to October 2021,the clinical data were reviewed for 101 children with congenital scoliosis hemivertebral deformity.Posterior hemivertebra resection and internal fixation were performed.Factors including age,gender,height,weight,Stamp score,blood glucose,fasting time,preoperative Cobb angle,correction rate,operated segment,osteotomy findings,operative duration and laboratory examinations were analyzed by linear regression.And the changes and predictors of CRP were examined during perioperative period.Results All operations were completed successfully.There were 43 boys and 58 girls with an age range of (6.4±3.5) years.Operative duration was (199.2±68.4) min with an average of 3 operated segments and scoliosis correction rate 90.6%.Multivariable linear regression analysis indicated that an elevated level of postoperative CRP was associated with age,preoperative Cobb angle,operative duration and number of operated segments.Operative segment ≥4,operative duration ≥157 min and preoperative Cobb angle ≥27°hinted at a higher level of CRP (all P<0.05).Conclusions Children with severe deformity,more fused levels and longer operative duration tend to carry a greater risk of a higher postoperative level of CRP.
参考文献/References:
[1] Pahys JM,Guille JT.What’s new in congenital scoliosis?[J].J Pediatr Orthop,2018,38(3):e172-e179.DOI:10.1097/BPO.0000000000000922.
[2] McMaster MJ,Ohtsuka K.The natural history of congenital scoliosis.A study of two hundred and fifty-one patients[J].J Bone Joint Surg Am,1982,64(8):1128-1147.DOI:10.2106/00004623-198264080-00003.
[3] McMaster MJ,David CV.Hemivertebra as a cause of scoliosis.A study of 104 patients[J].J Bone Joint Surg Br,1986,68(4):588-595.DOI:10.1302/0301-620X.68B4.3733836.
[4] Nasca RJ,Stilling FH3rd,Stell HH.Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars[J].J Bone Joint Surg Am,1975,57(4):456-466.DOI:10.1016/0020-1383(75)90192-8.
[5] 祁新禹,张学军,白云松,等.后路半椎体切除短节段固定治疗儿童不平衡型多发半椎体的效果分析[J].中华小儿外科杂志,2017,38(9):686-690.DOI:10.3760/cma.j.issn.0253-3006.2017.09.009. Qi XY,Zhang XJ,Bai YS,et al.Posterior hemivertebra resection with short-segment internal fixation for unbalanced multiple hemivertebra in children[J].Chin J Pediatr Surg,2017,38(9):686-690.DOI:10.3760/cma.j.issn.0253-3006.2017.09.009.
[6] Sucato DJ.Management of severe spinal deformity:scoliosis and kyphosis[J].Spine (Phila Pa 1976),2010,35(25):2186-2192.DOI:10.1097/BRS.0b013e3181feab19.
[7] Clyne B,Olshaker JS.The C-reactive protein[J].J Emerg Med,1999,17(6):1019-1025.DOI:10.1016/s0736-4679(99)00135-3.
[8] Hashimoto K,Ikeda Y,Korenaga D,et al.The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma[J].Cancer,2005,103(9):1856-1864.DOI:10.1002/cncr.20976.
[9] Chung YG,Won YS,Kwon YJ,et al.Comparison of serum CRP and procalcitonin in patients after spine surgery[J].J Korean Neurosurg Soc,2011,49(1):43-48.DOI:10.3340/jkns.2011.49.1.43.
[10] Pathak A,Agrawal A.Evolution of C-reactive protein[J].Front Immunol,2019,10:943.DOI:10.3389/fimmu.2019.00943.
[11] Saul D,Hünicke P,B?ker KO,et al.Predicting the disaster-The role of CRP in acetabular surgery[J].Clin Biochem,2021,94:48-55.DOI:10.1016/j.clinbiochem.2021.04.020.
[12] Kruidenier J,Dingemans SA,Van Dieren S,et al.C-reactive protein kinetics and its predictive value in orthopedic (trauma) surgery:A systematic review[J].Acta Orthop Belg,2018,84(4):397-406.
[13] Straatman J,Cuesta MA,Schreurs WHH,et al.The PRECious trial PREdiction of complications,a step-up approach,CRP first followed by CT-scan imaging to ensure quality control after major abdominal surgery:study protocol for a stepped-wedge trial[J].Trials,2015,16:382.DOI:10.1186/s13063-015-0903-y.
[14] Al-Jabi Y,El-Shawarby A.Value of C-reactive protein after neurosurgery:a prospective study[J].Br J Neurosurg,2010,24(6):653-659.DOI:10.3109/02688697.2010.500408.
[15] Farrar MW,Hall GM.Neuroendocrine and inflammatory aspects of surgery:do they affect outcome?[J].Eur J Anaesthesiol,1998,15(6):736-739.DOI:10.1097/00003643-199811000-00020.
[16] 张瀚文,刘昊楠,赵梦奇,等.儿童先天性脊柱畸形患者围手术期加速康复管理方案的效果评价[J].中华医学杂志,2021,101(45):3730-3735.DOI:10.3760/cma.j.cn112137-20210430-01040. Zhang HW,Liu HN,Zhao MQ,et al.Effect of perioperative accelerated rehabilitation management program for children with congenital spinal deformity[J].Natl Med J China,2021,101(45):3730-3735.DOI:10.3760/cma.j.cn112137-20210430-01040.
[17] Rohleder N,Schommer NC,Hellhammer DH,et al.Sex differences in glucocorticoid sensitivity of proinflammatory cytokine production after psychosocial stress[J].Psychosom Med,2001,63(6):966-972.DOI:10.1097/00006842-200111000-00016.
[18] Pearle AD,Scanzello CR,George S,et al.Elevated high-sensitivity C-reactive protein levels are associated with local inflammatory findings in patients with osteoarthritis[J].Osteoarthritis Cartilage,2007,15(5):516-523.DOI:10.1016/j.joca.2006.10.010.
[19] Park JH,Rasouli MR,Mortazavi SMJ,et al.Predictors of perioperative blood loss in total joint arthroplasty[J].J Bone Joint Surg Am,2013,95(19):1777-1783.DOI:10.2106/JBJS.L.01335.
[20] Bordin JO,Chiba AK,Carvalho KI,et al.The effect of unmodified or prestorage white cell-reduced allogeneic red cell transfusions on the immune responsiveness in orthopedic surgery patients[J].Transfusion,1999,39(7):718-723.DOI:10.1046/j.1537-2995.1999.39070718.x.
[21] Aono H,Ohwada T,Kaneko N,et al.The post-operative changes in the level of inflammatory markers after posterior lumbar interbody fusion[J].J Bone Joint Surg Br,2007,89(11):1478-1481.DOI:10.1302/0301-620X.89B11.19478.
[22] Karol LA.The natural history of early-onset scoliosis[J].J Pediatr Orthop,2019,39(Issue 6,Supplement 1):S38-S43.DOI:10.1097/BPO.0000000000001351.
[23] Greenawalt JA,Zernell D.Autologous blood transfusion for postpartum hemorrhage[J].MCN Am J Matern Child Nurs,2017,42(5):269-275.DOI:10.1097/NMC.0000000000000359.
[24] Roets M,Sturgess DJ,Obeysekera MP,et al.Intraoperative cell salvage as an alternative to allogeneic (donated) blood transfusion:a prospective observational evaluation of the immune response profile[J].Cell Transplant,2020,29:963689720966265.DOI:10.1177/0963689720966265.
[25] Song BM,Kadhim M,Shanmugam JP,et al.Enhanced recovery after pediatric scoliosis surgery:key components and current practice[J].Orthopedics,2020,43(5):e338-e344.DOI:10.3928/01477447-20200721-06.
[26] Kehlet H.Surgical stress response:does endoscopic surgery confer an advantage?[J].World J Surg,1999,23(8):801-807.DOI:10.1007/s002689900583.
[27] Shaffer WO,Baisden JL,Fernand R,et al.An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery[J].Spine J,2013,13(10):1387-1392.DOI:10.1016/j.spinee.2013.06.030.
[28] 舒强,钭金法.加速康复外科在小儿外科中的应用与展望[J].临床小儿外科杂志,2019,18(4):253-256.DOI:10.3969/j.issn.1671-6353.2019.04.001. Shu Q,Tou JF.Applications and future prospects of enhanced recovery after surgery during pediatric surgery[J].DOI:10.3969/j.issn.1671-6353.2019.04.001.
相似文献/References:
[1]柏松,李晓峰,袁峰,等.单源化手术治疗肺动脉闭锁合并室间隔缺损及重要主肺动脉侧支血管[J].临床小儿外科杂志,2010,9(06):410.
BAI Song,LI Xiao feng,YUAN Feng,et al.Unifocalization repair for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries.[J].Journal of Clinical Pediatric Surgery,2010,9(06):410.
[2]麻晓鹏,王涛,祖莹,等.肺动脉平滑肌细胞钙含量与先心病肺动脉高压的关联性研究[J].临床小儿外科杂志,2008,7(01):9.
[3]张网林,陈秋.持续光照与松果体切除诱导大鼠脊柱侧凸动物模型的探讨[J].临床小儿外科杂志,2008,7(02):8.
[4]张勇,张立根,张敬悌,等.SRS-22问卷在中国儿童和青少年脊柱侧凸患者中的应用[J].临床小儿外科杂志,2008,7(02):9.
[5]梅海波. 包裹式自体髂骨移植治疗儿童先天性胫骨假关节的疗效观察[J].临床小儿外科杂志,2011,10(03):163.
[6]袁峰 李晓峰 柏松 郭健 宋振江 赵宇东 李仲智.体重5kg以下完全性肺静脉异位引流患儿的外科治疗[J].临床小儿外科杂志,2011,10(03):184.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):184.
[7]方炜 丁力 张峰 胡英超 陈雨青. 婴幼儿法乐四联症手术治疗近期疗效的影响因素[J].临床小儿外科杂志,2011,10(06):403.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):403.
[8]柳立平 何萍萍 孔 英 朱丽敏 徐卓明. 先天性心脏病延迟关胸患儿胸骨缝合术前后[J].临床小儿外科杂志,2011,10(06):407.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):407.
[9]闫英群 靖文斌. 低龄儿童法乐四联症根治术中右室流出道疏通的策略[J].临床小儿外科杂志,2011,10(06):414.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):414.
[10]汪力 皮名安 龚立 王涛. 小儿先心病并感染性心内膜炎手术治疗中的体外循环技术[J].临床小儿外科杂志,2011,10(06):417.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):417.
[11]黄琦,徐江龙,宿玉玺,等.一期后路半椎体切除短节段融合术治疗先天性半椎体畸形的多中心研究[J].临床小儿外科杂志,2024,(06):521.[doi:10.3760/cma.j.cn101785-202405076-004]
Huang Qi,Xu Jianglong,Su Yuxi,et al.Efficacy of one-stage posterior hemivertebrectomy and short segment fusion for congenital hemivertebra malformations:a multicenter clinical study[J].Journal of Clinical Pediatric Surgery,2024,(06):521.[doi:10.3760/cma.j.cn101785-202405076-004]
备注/Memo
收稿日期:2022-03-25。
基金项目:北京市自然科学基金(L222095)和新疆维吾尔自治区重点研发任务专项项目(2023B03018)
通信作者:张学军,Email:zhang-x-j04@163.com