患儿体外循环直视心脏术后高尿酸血症分析

目的：探讨体外循环心脏术后24h患儿高尿酸血症发生的原因、影响因素和预后。方法：以2006年9～12月我院心脏外科收治的106例体外循环心脏手术患儿为研究对象，收集其年龄、体外循环时间、尿量、预后资料和心脏术后24h血尿酸、尿素氮、肌酐、胱抑素、血糖、总胆红素、直接胆红素等生化指标数据；以空腹血尿酸为标准，将患儿分为无高尿酸血症组和高尿酸血症组，用SPSS11．0软件分析两组之间临床资料的差异、高尿酸血症组血尿酸与其他指标的相关性及影响患者预后的因素。结果：患儿术后高尿酸血症组患者53例（50％），与无高尿酸血症组相比P〈0．01，除年龄因素外，其他临床指标均有统计学意义；高尿酸血症组的血尿酸与血糖、总胆红素无相关性，与年龄、尿量呈显著负相关，与转流时间、尿素氮、肌酐、胱抑素、直接胆红素含量呈极显著正相关；在预后良好组与死亡组的比较中，转流时间、血尿酸、尿素氮、肌酐含量有统计学意义。结论：患儿体外循环心脏术后高尿酸血症的发生较常见，血尿酸水平对患者术后肾功能状态及预后具有重要临床意义，连续监测术后血尿酸、尿素氮、肌酐水平是及时判断患者临床状况以采取相应措施改善预后的重要方法；低心排血量综合征是引起患者死亡的危险因素之一，通过提高体外循环心脏手术水平，尽量缩短转流时间，加强围手术期监护，可有效减少术后并发症，降低死亡率。

The Analysis of 24 Hours Post Cardiac Surgery Hyperuricemia with Cardiopulmonary Bypass for Children Patients

Objective To explore the respective cause, influencing factors and prognosis of hyperuricemia 24 hours post cardiac surgery with cardiopulmonary bypass（CBP） of suffering children. Methods The sample of 106 children patients undergone CBP cardiac surgery in the Guangzhou General Hospital was studied, and the relative data was collected, such as the patients＂ age, CBP time, urine volume of 24 hours post cardiac surgery, prognosis information, and the biochemical indexes 24 hours post surgery including uric acid, urea, creatine, cystatin C, serum glucose, bilirubina. Taking serum uric acid （SUA） as the standard, the children patients were divided into No Hyperuricemia Group and Hyperuricemia Group. SPSS11.0 software was introduced in analysis of the two groups＂ difference in clinical information, the relativity between uric acid and other indexes with in the Hyperurieemia Group, and factors affecting patients＂ prognosis. Results For the 53 children patients in the Hyperuricemia Group （50% of total）, comparing with No Hyperuricemia Group, all other clinical indexes except age factor were statistically meaningful. For the Hyperuricemia Group, SUA was not related with serum glucose or bilirubina, but demonstrated a significant negative-relatedness with age and urine volume; and highly significant positive-relatedness with the duration of CBP, urea, creatine, cystatin C and conjugated bilirubina. In comparing the prognosis living group and death group, indexes like the duration of CPB, uric acid, urea and creatine were statistically meaningful. Conclusion With relatively high occurrence frequency of hyperuricemia after cardiac surgery with cardiopulmonary bypass, the uric acid level is crucial for the patients＂ post-surgery kidney function. A continuous monitoring of postsurgery level of uric acid, urea and creatine, would be important in timely judging patients＂ clinical condition and adopting corresponding measures in improving prognosis. Low cardiac output syndrome is a perilous factor causi