复杂先天性心脏病矫治术后的快速康复研究  

Fast track treatment following cardiac surgery in patients with complex congenital heart disease

作　　者：曾敏[1] 李守军[2] 王旭[1] 阎军[2] 晏馥霞[3] 李霞[1] 

机构地区：[1]中国医学科学院 中国协和医科大学 阜外心血管病医院小儿外科中心PICU,北京100037 [2]中国医学科学院 中国协和医科大学 阜外心血管病医院小儿心脏外科,北京100037 [3]中国医学科学院 中国协和医科大学 阜外心血管病医院麻醉科,北京100037

出　　处：《岭南心血管病杂志》2012年第2期117-121,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探索复杂先天性心脏病快速康复(fast track,FT)的可行性和安全性,探讨其相关影响因素。方法回顾性分析2008年1月至2010年6月阜外心血管病医院小儿外科中心复杂先天性心脏病矫治术后患者865例的临床资料。病种包括:法洛四联症,肺动脉闭锁、右心室双出口,大动脉转位,肺静脉畸形引流,心内膜垫缺损,主动脉缩窄合并室间隔缺损等。分析先天性心脏病手术风险分级评估(risk adjustment forcongenital heart surgery 1,RACHS-1),病种类型、年龄、体质量等因素对FT的影响。结果总体FT比率为42.65%。按年龄分组(0～6个月、6～12个月以及>12个月)3组FT比率分别为19.70%、40.20%、62.61%,3组间比较差异有统计学意义(P<0.05)。FT组机械通气时间、重症监护病房住院时间比非FT组明显降低,差异有统计学意义[(6.51±4.06)h vs.(58.07±74.81)h,P<0.05;(2.05±1.06)d vs.(7.64±8.75)d,P<0.05]。Logistic回归分析提示年龄、体质量、高RACHS-1分级是复杂先天性心脏病FT治疗影响因素。结论部分复杂先天性心脏病矫治术后可行FT治疗,高RACHS-1风险分级、疾病类型、年龄<6个月是复杂先天性心脏病矫治术后FT的影响因素。Objectives To access the feasibility and safety of fast track（FT） treatment in patients with complex congenital heart disease who received congenital cardiac surgery,and to discuss risk factors of FT treatment.Methods We retrospectively summarized the clinic data of 865 patients with complex congenital heart disease who underwent operations in Fuwai Hospital from January 2008 to June 2010.Patients with tetralogy of Fallot,pulmonary atresia,double outlet right ventricle transposition of the great arteries,total anomalous pulmonary venous connection,endocardial cushion defects and aortic coarctation combine with ventricular septal defect were all included in this study.The risk factors [risk adjustment for congenital heart surgery 1（RACHS-1）,disease entity,age,body weight ] of FT treatment were analyzed by Logistic regression method.Results Totally 42.65% of the patients successfully achieved FT treatment.All patients were divided into 3 groups according to age.The FT rate in 0-6 months group,6-12 months group,12 months group were 19.70%,40.20%,62.61%,and the difference among them was significant（P0.01）.Duration of mechanical ventilation and intensive care unit stay were decreased in FT group compared with non FT group[（6.51±4.06）h vs.（58.07±74.81） h,P0.05;（2.05±1.06） d vs.（7.64±8.75） d,P0.05].Logistic regression analysis indicated that high RASCHS-1 risk category,age,body weight were risk factors of FT treatment.Conclusions FT treatment can be achievable for certain patients with complex congenital heart disease who received cardiac surgery.High RASCHS-1 risk category,disease entity,age 6 months may be risk factors related to FT treatment.

关 键 词：心脏缺损 先天性 外科治疗 快速康复 影响因素 

分 类 号：R541.1[医药卫生—心血管疾病]