完全性肺静脉异位引流术后低心排血量综合征的相关危险因素分析  

Risk factors for low cardiac output syndrome after total anomalous pulmonary venous connection correction

作　　者：毛俊[1] 许耀强[1] 陈炎 贺彦[1] 范祥明[1] 程沛[1] 苏俊武[1] Mao Jun;Xu Yaoqiang;Chen Yan;He Yan;Fan Xiangming;Cheng Pei;Su Junwu(Center of Pediatric Cardiology,Beijing Anzhen Hospital,Capital Medical University,Being Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

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

出　　处：《中华危重症医学杂志（电子版）》2020年第4期253-257,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的分析完全性肺静脉异位引流(TAPVC)术后低心排血量综合征(LCOS)的危险因素。方法选择从2014年1月至2018年1月在首都医科大学附属北京安贞医院小儿心脏中心进行TAPVC术的153例患儿,根据术后是否出现LCOS,将患儿分为LCOS组(50例)和无LCOS组(103例)。比较两组患儿术前、术中及术后的临床资料,采用Logistic回归分析TAPVC术后LCOS的影响因素。结果LCOS组患儿围手术期病死率显著高于无LCOS组[22.0%(11/50)vs.3.9%(4/103),χ^2=12.493,P<0.001]。LCOS组和无LCOS组患儿年龄[3(1,5)个月vs.5(2,12)个月,H=2.722,P=0.006]、体质量[5.2(4.5,6.0)kg vs.6.0(5.0,8.0)kg,H=3.519,P<0.001]、术前左心室舒张末期内径[15(13,17)mm vs.18(15,23)mm,H=4.170,P<0.001]、术前房间隔缺损大小[6(4,8)mm vs.8(6,11)mm,H=3.368,P=0.001]、术前血氧饱和度[85(80,86)%vs.85(82,87)%,H=2.168,P=0.030]、术中体外循环时间[100(75,137)min vs.88(70,109)min,H=2.459,P=0.014]及是否延迟关胸(χ^2=4.484,P=0.034)比较,差异均有统计学意义。将年龄、体质量、术前左心室舒张末期内径、术前房间隔缺损大小、术前血氧饱和度、延迟关胸及术中体外循环时间纳入Logistic回归分析,结果显示,术前左心室舒张末期内径[比值比(OR)=0.851,95%置信区间(CI)(0.732,0.989),P=0.035]、术前血氧饱和度[OR=0.901,95%CI(0.829,0.979),P=0.014]是行TAPVC术后出现LCOS的保护因素,而术中体外循环时间[OR=1.012,95%CI(1.001,1.022),P=0.028]是其危险因素。结论应密切关注TAPVC患儿术前左心室舒张末期内径、血氧饱和度及术中体外循环时间,若发现LCOS的征象,应尽早干预以改善患儿的预后。Objective To study risk factors for the low cardiac output syndrome(LCOS)after total anomalous pulmonary venous connection(TAPVC)correction.Methods Totally 153 child patients undergoing TAPVC correction were selected from the Center of Pediatric Cardiology of Beijing Anzhen Hospital,Capital Medical University between January 2014 and January 2018.They were divided into a LCOS group(n=50)and a no LCOS group(n=103)according to whether the LCOS appeared after operation.Clinical data before,during and after operation were compared between the two groups,and risk factors of LCOS after TAPVC correction were analyzed by Logistic regression analysis.Results The perioperative mortality of child patients in the LCOS group was significantly higher than that in the no LCOS group[22.0%(11/50)vs.3.9%(4/103),χ^2=12.493,P<0.001].The age[3(1,5)months vs.5(2,12)months,H=2.722,P=0.006],body mass[5.2(4.5,6.0)kg vs.6.0(5.0,8.0)kg,H=3.519 P<0.001],preoperative left ventricular end-diastolic diameter[15(13,17)mm vs.18(15,23)mm,H=4.170,P<0.001],preoperative atrial septal defect size[6(4,8)mm vs.8(6,11)mm,H=3.368,P=0.001],preoperative oxygen saturation[85(80,86)%vs.85(82,87)%,H=2.168,P=0.030],intraoperative cardiopulmonary bypass time[100(75,137)min vs.88(70,109)min,H=2.459,P=0.014]and delayed chest closure(χ^2=4.484,P=0.034)were statistically significantly different between the LCOS group and no LCOS group.Then the age,body mass,preoperative left ventricular end-diastolic diameter,preoperative atrial septal defect size,preoperative oxygen saturation,delayed chest closure and intraoperative cardiopulmonary bypass time were included in the Logistic regression analysis.The results showed that the preoperative left ventricular end-diastolic diameter[odds ratio(OR)=0.851,95%confidence interval(CI)(0.732,0.989),P=0.035]and preoperative oxygen saturation[OR=0.901,95%CI(0.829,0.979),P=0.014]were protective factors of LCOS after TAPVC correction,and the intraoperative cardiopulmonary bypass time[OR=1.012,95%CI(1.001,1.022),P=0.028]was its risk

关 键 词：低心排血量综合征 先天性心脏病 完全性肺静脉异位引流 危险因素 

分 类 号：R726.5[医药卫生—儿科]