ALCAPA伴左心功能中重度不全患儿矫治术后早期发生FO的危险因素及其对临床结局的影响  

Risk factors for early fluid overload following repair in pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction and the effect on clinical outcomes

作　　者：王春蓉[1] 龚俊松[1] 石晟[1] 王剑辉[1] 高宇晨 王苏德娜 晏馥霞[1] 王越夫[1] Wang Chunrong;Gong Junsong;Shi Sheng;Wang Jianhui;Gao Yuchen;Wang Sudena;Yan Fuxia;Wang Yuefu(Department of Anesthesiology,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院麻醉中心,100037

出　　处：《中华麻醉学杂志》2019年第9期1099-1103,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价左冠状动脉异常起源于肺动脉(ALCAPA)伴左心功能中重度不全(LVEF<50%)患儿矫治术后早期发生液体超负荷(FO)的危险因素及其对临床结局的影响。方法ALCAPA伴术前左心功能中重度不全危重患儿43例,月龄2~128月,体重4.5~34.5 kg,NYHA分级Ⅲ或Ⅳ级。根据术后24 h内FO,将患儿分为FO≥5%组和FO<5%组。采用pRIFLE标准评价术后急性肾损伤的发生情况。比较2组患儿年龄、身高、体重、术前LVEF、术前生化指标、手术资料、术后机械通气时间、ICU停留时间及术后相关临床结局指标。将组间差异有统计学意义的变量纳入多因素logistic回归分析,筛选术后24 h内发生FO≥5%的危险因素,及FO≥5%对术后严重急性肾损伤(I级+F级)、机械通气时间、ICU停留时间等的影响。结果14例患儿术后早期发生FO≥5%,发生率为33%。logistic回归结果显示:术前LVEF偏低是术后早期发生FO≥5%的独立危险因素(P<0.05)。与FO<5%组比较,FO≥5%组患儿术后机械通气时间及ICU停留时间均明显延长,发生肺部感染和需要二次气管插管的患儿例数明显增多,ICU停留时间超过14 d的患儿例数也显著增多(P<0.05),其它各临床结局指标差异无统计学意义(P>0.05)。结论术前LVEF偏低是ALCAPA伴左心功能中重度不全患儿矫治术后早期发生FO的危险因素;若术后早期发生FO≥5%,不利于患儿的临床结局。Objective To identify the risk factors for early fluid overload(FO)following repair in the pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)complicated with moderate or severe left ventricular dysfunction(left ventricular ejection fraction[LVEF]<50%)and evaluate the effect on clinical outcomes.Methods Forty-three pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction,aged 2-128 months,weighing 4.5-34.5 kg,with New York Heart AssociationⅢorⅣ,undergoing ALCAPA repair,were enrolled in this study.The pediatric patients were divided into FO≥5%group(n=14)and FO<5%group(n=29)according to the FO developed within 24 h after operation.The pediatric Risk,Injury,Failure,Loss,and End-Stage Renal Disease criterion was used to diagnose acute kidney injury developed after operation.Factors including age,height,weight,preoperative LVEF,preoperative biomarkers,operative data,postoperative ventilation time,duration of intensive care unit(ICU)stay and related postoperative clinical outcome parameters were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for FO≥5%developed within 24 h after operation.The effect of FO≥5%on postoperative severe acute kidney injury(Injury and Failure),ventilation time,duration of ICU stay and etc.was assessed.Results Fourteen cases developed early postoperative FO≥5%,and the incidence was 33%.The results of the logistic regression analysis showed that lower preoperative LVEF was an independent risk factor for early postoperative FO≥5%(P<0.05).Compared with FO<5%group,the postoperative ventilation time and duration of ICU stay were significantly prolonged,the number of pediatric patients who developed pulmonary infection and required reintubation was increased,the number of pediatric patients in whom duration of ICU stay was more than 14 days was increased(P<0.05),and no significant change was foun

关 键 词：冠状动脉疾病 肺动脉 危险因素 预后 儿童 液体超负荷 

分 类 号：R726.5[医药卫生—儿科]