儿童先天性心脏病封堵术后发生心血管事件的影响因素分析  

Analysis of influencing factors of cardiovascular events after closure of congenital heart disease in children

作　　者：李芬[1] 全勇 宋青青[1] 张弦[1] 徐霞[1] 肖志容[1] 陈智[1] LI Fen;QUAN Yong;SONG Qing qing;ZHANG Xian;XU Xia;XIAO Zhi-rong;CHEN Zhi(Department of Cardiovuscular,Huan Chldren's Hospital,Changsha 410000,China;Depurtment of Cardionascular,The Third Hospital of Changsha,Changsha 410000,China)

机构地区：[1]湖南省儿童医院心血管内科,长沙410000 [2]长沙市第三医院心血管内科,长沙410000

出　　处：《临床药物治疗杂志》2019年第12期44-48,共5页Clinical Medication Journal

基　　金：湖南省儿童医院院内科学研究基金项目(D2017-0228)。

摘　　要：目的:探究儿童先天性心脏病(congenital heart disease,CHD)封堵术后发生心血管事件的影响因素。方法:回顾性分析2015年12月至2017年2月于湖南省儿童医院行封堵术治疗的120例CHD患儿的临床资料,根据术后18个月内是否发生主要不良心血管事件(major adverse cardiovascular events,MACE),分为MACE组及无MACE组。比较2组患儿基线资料、封堵术情况、血液学指标及阿司匹林用药依从性,应用COX回归分析MACE的影响因素。结果:随访至18个月时,共发生MACE 16例;随访至6个月时,患儿用药依从性从出院时的100%下降至89.17%,其中13例患儿完全停用阿司匹林;MACE组患儿出院后1、3、6个月Morisky评分显著低于无MACE组(P<0.05),差异有统计学意义;术后6个月,2组患儿Hb、血糖、SCr、BUN、AST、ALT、TG、TC和HDL-C水平差异无统计学意义(P>0.05),MACE组PLT[(256.84±59.06)vs.(223.96±58.21)]×10^9·L^-1、LDL-C[(2.85±0.82)vs.(2.43±0.71)]mmd·L^-1,明显高于无MACE组(t=2.099,2.158,P=0.038,0.033);多因素COX回归分析显示,阿司匹林用药依从性为术后发生MACE的影响因素(HR=0.026,P=0.000)。结论:提高阿司匹林用药依从性,可降低儿童CHD封堵术后发生MACE,改善疾病预后。Objective:To investigate the influencing factors of cardiovascular events after closure of congenital heart disease(CHD)in children.Methods:From December 2015 to February 2017,a retrospective analysis was made on 120 children with congenital heart disease who underwent occlusion treatment in Hunan Children’s Hospital.According to the occurrence of major adverse cardiovascular events(MACE)within 18 months after operation,they were divided into MACE group and non-MACE group.Compare the compliance of aspirin use,general data,occlusion situation,and hematological parameters between the two groups.COX regression model was used to analyze the influencing factors for MACE.Results:Follow up to 18 months,a total of 16 cases of MACE occurred.During the follow-up period of 6 months,the aspirin compliance of children decreased from 100%at discharge to 89.17%.Among them,13 children completely stopped using aspirin.The Morisky scores in MACE group were significantly lower than those in non-MACE group at 1,3 and 6 months after discharge(P<0.05).6 months after the operation,there was no significant difference in the levels of Hb,blood sugar,SCr,BUN,AST,ALT,TG,TC and HDL-C between the two groups(P>0.05).The levels of PLT and LDL-C in MACE group were[(256.84±59.06)vs.(223.96±58.21)]×10^9·L^-1 and LDL-C[(2.85±0.82)vs.(2.43±0.71)]mmol·L^-1,which were significantly higher than those in non-MACE group(t=2.099,2.158,P=0.038,0.033).Multivariate COX regression analysis showed that aspirin compliance was the influencing factor for postoperative MACE(HR=0.026,P=0.000).Conclusion:Improving the compliance of aspirin can reduce the incidence of MACE and improve the prognosis of children with congenital heart disease.

关 键 词：先天性心脏病 阿司匹林 用药依从性 心血管事件 

分 类 号：R726.5[医药卫生—儿科]