背景:在心脏大手术期间,钙和维生素D对围手术期左心室(LV)性能的影响仍未被研究。我们旨在评估在不同时间点测量的钙和维生素D与左心室射血分数(EF)的关系,并调查EF的变化是否与术后结局相关。方法:我们招募了83例患者,之前测量过离子钙,during,手术后(直到出院),术前维生素D,术前和术后24hEF。术后结局为体外循环(CPB)时间,主动脉交叉钳夹时间,机械通气时间,血管活性肌力评分(VIS)(术中,第0天,第1天),ICU停留时间。结果:平均年龄为64.9±8.5岁,其中21名患者(25%)的EF<50%。术前到术后EF的中位数变化为-2.0(-10.0-0.0)%(p<0.001)。在基线,EF<50%组术前维生素D水平显著低于EF≥50%组(p=0.048).各组之间的钙趋势没有差异。术前EF与CPB时间(r=0.22,p=0.044)和主动脉阻断时间(r=0.24,p=0.031)显著相关。术后EF与术中VIS呈显著负相关(r=-0.28,p=0.009),VIS第0天(r=-0.25,p=0.020),VIS第1天(r=-0.23,p=0.036),和ICU住院时间(r=-0.22,p=0.047)。最后,射血分数的变化与CPB时间呈显著负相关(r=-0.23,p=0.037),主动脉阻断时间(r=-0.22,p=0.044),术中VIS(r=-0.42,p<0.001),VIS第0天(r=-0.25,p=0.024),机械通气时间(r=-0.22,p=0.047),和ICU住院时间(r=-0.23,p=0.039)。结论:围手术期离子钙水平的波动与LVEF的演变无关,尽管术前维生素D水平可能会影响EF低的患者。相应地,EF降低显著影响所有研究的术后结局.有必要对影响心脏收缩功能的生物标志物进行进一步研究,以更好地了解其重要性。
Background: The perioperative impact of calcium and vitamin D on left ventricular (LV) performance during major cardiac surgery remains unexplored. We aimed to assess the relation of calcium and vitamin D measured at different time points with the LV ejection fraction (EF), and to investigate whether changes in EF correlate with postoperative outcomes. Methods: We enrolled 83 patients, in whom ionized calcium was measured before, during, and after surgery (until discharge), vitamin D preoperatively, and EF pre- and postoperatively at 24 h. The postoperative outcomes were cardiopulmonary bypass (CPB) time, aortic cross-clamp time, mechanical ventilation time, vasoactive inotropic score (VIS) (intraoperative, day 0, day 1), and ICU stay time. Results: The mean age was 64.9 ± 8.5 years, with 21 of the patients (25%) having an EF < 50%. The median change from preoperative to postoperative EF was -2.0 (-10.0-0.0) % (p < 0.001). At the baseline, the EF < 50% group had significantly lower preoperative vitamin D levels than the EF ≥ 50% group (p = 0.048). The calcium trend did not differ across the groups. Preoperative EF was significantly associated with CPB time (r = 0.22, p = 0.044) and aortic cross-clamp time (r = 0.24, p = 0.031). Postoperative EF was significantly and inversely associated with intraoperative VIS (r = -0.28, p = 0.009), VIS day 0 (r = -0.25, p = 0.020), VIS day 1 (r = -0.23, p = 0.036), and ICU length of stay (r = -0.22, p = 0.047). Finally, the change in ejection fraction was significantly and inversely associated with CPB time (r = -0.23, p = 0.037), aortic cross-clamp time (r = -0.22, p = 0.044), intraoperative VIS (r = -0.42, p < 0.001), VIS day 0 (r = -0.25, p = 0.024), mechanical ventilation time (r = -0.22, p = 0.047), and ICU length of stay (r = -0.23, p = 0.039). Conclusions: The fluctuations in perioperative ionized calcium levels were not associated with the evolution of LVEF, although preoperative vitamin D levels may affect those with low EF. Correspondingly, a reduced EF significantly impacted all the studied postoperative outcomes. Further investigation into biomarkers affecting cardiac inotropic function is warranted to better understand their significance.