小体质量法洛四联症患儿术后毛细血管渗漏综合征发生的相关因素分析  

Analysis of the factors for postoperative blood capillary leak syndrome of small weight of tetralogy of fallot

作　　者：张汀洲[1] 贺彦[1] 刘迎龙[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏中心重症监护室,100029

出　　处：《心肺血管病杂志》2016年第1期41-44,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：对小体质量法洛四联症患儿（〈10kg）术后毛细血管渗漏综合征的发生进行相关因素分析。方法：回顾北京安贞医院小儿心脏外科,2014年1月1日至2014年12月31日,行法洛四联症矫治术的183例患儿,〈10kg的患儿为95例。其中10kg以下渗漏者有25例,非渗漏者有70例两者进行统计学分析。选择与法洛四联症矫治术后渗漏关系密切的因素作为可能的危险因素,包括刚入ICU的中心静脉压（CVP）、年龄、Mcgoon值、侧枝情况、阻断时间、体外循环时间、最低体温、复温时间与体外循环时间比值（R/C）、体外总血容量与预充量比值（A/P）及术中血管活性药指数（IS）,是否进行右心室切口、是否跨肺动脉瓣环进行修补及是否应用牛颈静脉带瓣跨环补片,体外总血容量包括自身血容量及体外补充胶体量,其中自身血容量以80m L/kg计算。结果：在刚入ICU中心静脉压（CVP）、阻断时间、体外循环时间、术中血管活性药指数方面渗漏组较未渗漏组显著增加,而复温时间与体外循环时间比值、体外总血容量与预充量比值方面渗漏组较未渗漏组显著减少。多因素Logistics逐步回归分析结果显示,体外总血容量与预充量比值（B=-4.882,OR=0.008,95%CI：0.001~0.103,P=0.000）、复温时间与体外循环时间比值（B=-2.841,OR=0.058,95%CI：0.006~0.583,P=0.016）对渗漏的影响显著,对应的P〈0.05,且为负向影响;术中刚入ICU的中心静脉压（CVP）（B=0.414,OR=1.513,95%CI：1.142~2.006,P=0.004）对渗漏的影响显著,对应的P〈0.05,且为正向影响。结论：体外总血容量与预充量比值、复温时间与体外循环时间比值对渗漏的影响显著,比值增高,发生渗漏可能性降低;术中刚入ICU的CVP对渗漏的预测力显著,数值升高,渗漏发生率越高。Objective： The analysis of related factors about the small weight children with tetralogy of fallot（ 10 kg） of postoperative capillary leak syndrome. Methods： 183 children underwent tetralogy of fallot corrective surgery at the beijing anzhen hospital pediatric cardiac center from January 1,2014 to December 31,2014. The children with less than 10 kg were 95 cases. The leakage group was 25 cases,the without leakage cases made statistical analysis. Selecting the closely related factors about postoperative leakage of tetralogy of fallot as possible risk factors,the CVP for just entering ICU after surgery,age,Mcgoon value,collateral,the blocking time,the lowest temperature,the cardiopulmonary bypass time,the rewarming time and the cardiopulmonary bypass ratio（ R / C）,altogether blood volume in vitro（ itself ＋ added colloidal volume） and priming quantity ratio（ A / P）,intraoperative vasoactive drugs index（ IS）,whether make the right ventricular incision,whether across the pulmonary valve ring for repair,whether use valved bovine jugular vein conduit,with their own blood volume 80 ml / kg. Results： In the aspects of the CVP for just entering ICU,the blocking time,the cardiopulmonary bypass time,intraoperative vasoactive drugs index,leakage group significantly is higher compared with less leakage group. In the aspects of the rewarming time and the cardiopulmonary bypass ratio（ R /C）,altogether blood volume in vitro（ itself ＋ added colloidal volume） and priming quantity ratio（ A / P）,leakage group significantly is lower compared with less leakage group. According to the results of single factor analysis of variance,we made multi-factor logistics stepwise regression analysis. The results showed that altogether blood volume in vitro（ itself ＋ added colloidal volume） and priming quantity ratio（ A / P）（ B value is-4. 882,OR = 0. 008,95% CI： 0. 001 ~ 0. 103,P = 0. 000）,the rewarming time and the cardiopulmonary bypass ratio（ R / C）（ B value is-2. 841,OR = 0. 058,

关 键 词：法洛四联症 毛细血管渗漏综合征 危险因素 晶体及胶体容量 复温及体外循环时间 

分 类 号：R54[医药卫生—心血管疾病]