Zhu Yu,Chen Xiaotian,Ye Ming,et al.Correlation between early postoperative inflammatory marker changes and antibiotic use in children with congenital heart disease[J].Journal of Clinical Pediatric Surgery,2026,(02):146-152.[doi:10.3760/cma.j.cn101785-202502003]
先天性心脏病患儿手术后早期炎症指标变化与抗生素使用的相关性研究
- Title:
- Correlation between early postoperative inflammatory marker changes and antibiotic use in children with congenital heart disease
- Keywords:
- Heart Diseases; Heart Diseases; Cardiac Surgical Procedures; Procalcitonin; C-Reactive Protein; Leukocyte Count; Anti-Bacterial Agents; Therapeutic Uses
- 摘要:
- 目的 探讨先天性心脏病(以下简称先心病)手术后早期炎症指标变化对于抗生素使用的指导价值,为先心病手术后抗感染治疗提供依据。方法 本研究为回顾性队列研究,以2021年1月1日至2022年12月31日复旦大学附属儿科医院心脏监护室收治的806例先心病手术后患儿为研究对象,其中男448例、女358例,平均年龄3.07岁,平均体重14.50 kg。收集患儿基本信息及术后第1天血白细胞计数(white blood cell,WBC)、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)等炎症指标数据。依据手术后抗生素是否升级分为抗生素升级组(n=464)和抗生素未升级组(n=342)。组间比较采用两独立样本t检验、秩和检验、卡方检验,对WBC计数、PCT、CRP进行多因素Logistic回归分析。结果 两组患儿年龄、体重、身高、手术RACHS-1分级(risk adjustment for congenital heart surgery-1,RACHS-1)、体外循环时间及主动脉阻断时间差异均具有统计学意义(P<0.001);两组术后第1天CRP、WBC和PCT差异均具有统计学意义(P<0.001)。将CRP、WBC、PCT按升高程度由低到高依次分为4组(Q1~Q4组)进行趋势检验,WBC和PCT中度以上升高(Q3、Q4组)与抗生素升级具有相关性(P<0.05),其中WBC(OR=3.74,95%CI:2.16~6.60,P<0.001)和PCT(OR=2.57,95%CI:1.56~4.27,P<0.001)升高最显著的Q4组与抗生素升级关联性最强。结论 低龄、低体重和接受复杂心脏手术的患儿更倾向于进行抗生素升级。相较于CRP,术后早期PCT、WBC计数显著升高对于指导先心病手术后抗生素使用更有意义。
- Abstract:
- Objective To explore the guiding value of early postoperative inflammatory marker changes for antibiotic use after surgery for congenital heart disease (CHD),and to provide evidence for postoperative anti-infective treatment in children with CHD. Methods This was a retrospective cohort study included 806 children who underwent surgery for CHD and were admitted to the Cardiac Care Unit of the Children’s Hospital of Fudan University between January 1,2021 and December 31,2022.Among them,448 were male and 358 were female,with a mean age of 3.07 years and a mean body weight of 14.50 kg.Baseline information and inflammatory markers on postoperative day 1,including white blood cell (WBC) count,C-reactive protein (CRP),and procalcitonin (PCT),were collected.According to whether postoperative antibiotics were escalated,patients were divided into an antibiotic escalation group (n=464) and a non-escalation group (n=342).Intergroup comparisons were performed using t-tests,rank-sum tests,and chi-square tests.Multivariate logistic regression analyses were conducted for WBC count,PCT,and CRP. Results Significant differences were observed between the two groups in age,body weight,height,Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) score,cardiopulmonary bypass (CPB) time,and aortic cross-clamp time (P<0.001).Significant differences were also found in postoperative day 1 CRP,WBC and PCT levels between the two groups (P<0.001).CRP,WBC,and PCT levels were divided into four groups (Q1-Q4) from low to high according to the degree of elevation,and trend tests were performed.Moderate-to-marked elevations of WBC and PCT (Q3 and Q4) were associated with antibiotic escalation (P<0.05).The strongest associations were observed in the Q4 groups with the highest elevations of WBC(OR=3.74,95%CI:2.16-6.60,P<0.001) and PCT(OR=2.57,95%CI:1.56-4.27,P<0.001). Conclusions Younger age,lower body weight,and more complex cardiac surgery are associated with a higher likelihood of antibiotic escalation.Compared with CRP,marked early postoperative elevations in PCT and WBC count are more meaningful for guiding antibiotic use after surgery for CHD.
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备注/Memo
收稿日期:2025-9-2。
基金项目:2024年医疗服务与保障能力提升(国家临床重点专科建设)(10000015Z155080000004);上海市2022年度"科技创新行动计划"医学创新研究专项(22Y11909300)
通讯作者:宓亚平,Email:miyaping126@126.com