低体质量新生儿先天性心脏病外科手术的危险因素  

An analysis of risk factors of open cardiac surgery in low body weight neonates

作　　者：陈浩[1] 徐志伟[1] 王浩[1] 杜欣为[1] 陆兆辉[1] 王顺民[1] 郑景浩[1] 张海波[1] 

机构地区：[1]上海交通大学附属上海儿童医学中心心胸外科,200127

出　　处：《中华胸心血管外科杂志》2017年第5期271-275,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：“十二五”国家科技支撑项目（2011BAI11B22）

摘　　要：目的 探讨合并先心病的低体质量新生儿外科手术的危险因素.方法 回顾性分析我院2006年1月至2015年12月期间709例新生儿开胸心脏手术资料.按手术体质量将患儿分为≤3 kg组（组1）和3～6kg组（组2）.根据主要疾病诊断、手术方式和术前风险评分进一步对患儿分组,进行单因素和多因素回归分析.结果 住院期间早期死亡比例组1为25.0％,组2为14.5％,组间差异有统计学意义低体质量组患儿室隔完整型大动脉转位手术的早期死亡比例明显增加;术前风险评分为2分的患儿组1术后早期死亡比例高于组2.多因素回归分析显示,低体质量组患儿的手术年龄、体质量以及主要手术方式与术后早期死亡无明显相关,而体外循环时间、主动脉阻断时间以及术后并发症是术后早期死亡的独立危险因素.结论 术中体外循环时间、主动脉阻断时间和术后并发症所反映的低体质量新生儿开胸术后围手术期血流动力学状态,强烈影响了患儿术后早期生存情况.低体质量本身与术后早期死亡并无明显相关.Objective To explore risk factors of cardiac surgery in neonates with low body weight.Methods Retrospective analysis was made in neonates weighing less than 3 kg at surgery（n =192;group 1） and 3 to 6 kg（n =517;group 2）,who had undergone open cardiac repairs from January 2006 to December 2015 at our institution.Patients were grouped according to the primary procedure performed and analyzed according to their weight at the time of surgical intervention.Patients were also analyzed according to preoperative risk scores.Univariate versus multivariate risk analysis was performed.Results Hospital early mortality in group 1 was 25.0％ （n =48） versus 14.5 ％ （n =75） in group 2 （P =0.001）.Compared with group 2,neonates in group 1 had a significantly higher mortality for simple arterial switch procedure.Lower body weight remained strongly associated with mortality risk after stratifying the population by preoperative risk scores category levels 2.Within group 1,age,weight at surgery,preoperative risk score and type of procedure were not associated with significant differences in early mortality.Cardio-pulmonary bypass time,aortic cross-clamp time and the presence of a surgical complication were independent risk factors for early mortality in group 1.Conclusion Among neonates weighing less than 3.0kg who underwent open cardiac surgery,perioperative hemodynamic status,reflected by bypass time,cross-clamp time,and surgical complications,strongly influenced early mortality.In contrast,low body weight itself was not associated with early mortality.

关 键 词：心脏缺损 先天性 低体质量 新生儿 开胸手术 危险因素 

分 类 号：R726.5[医药卫生—儿科]