完全性肺静脉异位引流(TAPVC)术后延迟拔管的危险因素分析  

Risk Factors for Prolonged Ventilation after Total Anomalous Pulmonary Venous Connection(TAPVC) Operation

作　　者：贺彦[1] 刘迎龙[1] 苏俊武[1] 程沛[1] 陈焱[1] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏科重症监护室,北京100029

出　　处：《中国胸心血管外科临床杂志》2016年第2期147-150,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探索完全性肺静脉异位引流(TAPVC)根治术后延迟拔管危险因素,进而指导临床准确选择拔管时机。方法回顾性分析北京安贞医院2011年1月至2013年12月诊断为TAPVC行根治手术97例生存患者的临床资料,男55例、女42例,中位数年龄4.4(2,12)个月。按机械通气时间是否长于平均值将患儿分为延迟拔管组(50例)和正常拔管组(47例),对比两组患儿术前、术中及术后各项变量,寻找影响通气时间的单因素变量,再将有意义的变量纳入logistic回归分析。结果 97例患儿机械通气中位数时间49(25,90)h,延迟拔管组50例。延迟拔管的单因素变量有年龄、体重、术前左心室舒张期末内径、房间隔交通大小、术后正性肌力药物评分、术后左心室舒张期末内径、术后肺静脉最大流速(P<0.01)及体外循环时间(P<0.05)。Logistic回归后退法显示,延迟拔管的危险因素是年龄(OR=0.804,95%CI 0.71,0.91)和术后肺静脉最大流速(OR=1.016,95%CI 1.00,1.03)。结论年龄和术后肺静脉最大流速是存活患儿延迟拔管的危险因素。Objective To investigate the risk factors for prolonged postoperative mechanical ventilation patients with total anomalous pulmonary venous connection （TAPVC）. Methods We retrospectively analyzed the clinical data of 97 survived TAPVC patients in our hospital between June 2011 and December 2013. There were 55 males and 42 females with age of 4.4 （2, 12） months. The patients ventilated longer than mean time were as a prolonged ventilated group （n=50） and the others as a normal group （n=47）. Perioperative variables between the two groups were compared and selected, then put into logistic regression analysis. Results For the 97 survived patients, the mean ventilation time is 49 （25, 90） hours. Age, weight, pre-operative left ventricular end-diastolic dimension, atrial septal defect （ASD） caliber, inotropic drug dosage, postoperative left ventricular end-diastolic dimension, maximum pulmonary venous velocity （P〈0.01）, and cardio- pulmonary bypass （CPB） time （P〈0.05） were statistically different between the two groups. In logistic regress analysis, age （OR=0.804 with 95%CI 0.71 to 0.91） and maximum pulmonary venous velocity （OR=1.016 with 95%CI 1.00 to 1.03） were risk factors for prolonged postoperative mechanical ventilation. Conclusion Age and maximum pulmonary venous velocity are the risk factors associated with prolonged postoperative mechanical ventilation in patients with TAPVC.

关 键 词：心脏缺损 先天性疾病 完全性肺静脉异位引流 机械通气 危险因素 

分 类 号：R726.5[医药卫生—儿科]