法洛四联症根治术后低心排血量综合征的危险因素与防治  

Risk factors and management strategies for low cardiac output syndrome in patients after total correction of tetralogy of Fallot

作　　者：周智恩 严善秀 何伦德 王道庄 李正国 邓硕曾[2] 

机构地区：[1]成都心血管病医院重症医学科,四川省610031 [2]阜外心血管病医院麻醉科

出　　处：《中国心血管病研究》2011年第12期888-891,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 分析法洛四联症（TOF）根治术后发生低心排血量综合征（LCOS）的危险因素,探讨其防治策略.方法 以2001年1月至2010年12月间连续191例施行TOF根治手术患儿为研究对象,进行术后LCOS危险因素的单因素分析和多因素Logistic回归分析.结果 术后发生LCOS 20例,发生率为10.47%,术后LCOS患者病死率为10.00%.单因素分析显示,患儿年龄、体质量、红细胞压积、术前脉搏血氧饱和度、跨环补片率、Nakata指数、体外循环时间、主动脉阻断时间、围术期意外事件、血管活性药物评分、呼吸机辅助时间、停留ICU时间与术后LCOS有关.经多因素Logstic回归分析显示,年龄≤6个月、Nakata指数＜140 mm2/m2、围术期意外、体外循环时间＞150 min为小儿TOF根治术后LCOS的危险因素.结论 TOF根治术后发生LCOS与患儿年龄、Nakata指数、围术期意外、体外循环时间有关.对具有LCOS高危因素的TOF手术患儿采取积极的防治措施,对防止TOF根治术后发生LCOS具有重要意义.Objective To analyze risk factors, prevention and management strategies of low cardiac output syndrome （LCOS） after total correction of tetralogy of Fallot. Methods Between January 2001 and December 2010, 191 patients undergoing open heart surgery were recruited for study.Univariate and multivariate logistic regression analysis were used to identify the risk factors. Results 20 patients （10.47%） developed LCOS. The mortality for LCOS was 10.00%（2/20）. Univariate risk factors included age at repair, weight, haematocrit before operation, oxygen saturation, patching astride annulus, Nakata index, cardiopulmonary bypass （CPB） time, aortic cross-clamping time, perioperative unexpected events, inotropie score, mechanical ventilation time and stay ICU time. Multivariate logistic regression analysis showed that less than six months of age, Nakata index〈140 mm2/m2, perloperative unexpected events and CPB time〉150 rain were risk factors. Conclusion The high risk factors of LCOS included age at repair, Nakata index, perioperative unexpected events and CPB time. Acute and effective treatments should be carried out in the children with high risk factors of LCOS following total correction of TOF. It would play an important role in the prevention, early diagnosis and management of LCOS.

关 键 词：法洛四联症 低心排血量综合征 危险因素 

分 类 号：R654.2[医药卫生—外科学]