先天性心脏病并非心脏畸形同期联合手术疗效分析  

Analysis of the effect of the simultaneous combined operation for congenital heart disease complicated with non-cardiac malformation

作　　者：张伟 屈昕芃 秦广宁[1] 王双兴 张辉[1] 罗毅[1] Zhang Wei;Qu Xinpeng;Qin Guangning;Wang Shuangxing;Zhang Hui;Luo Yi(Department of Cardiac Surgery,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院心脏外科,100020

出　　处：《中华实用儿科临床杂志》2020年第20期1571-1576,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：北京市医院管理局临床医学发展专项经费(XMLX201712);北京市医院管理局儿科学科协同发展中心儿科专项(XTZD20180301)。

摘　　要：目的:探索先天性心脏病并非心脏畸形患儿同期联合手术方案的安全性及可行性。方法:选取2017年1月至2019年1月在首都儿科研究所附属儿童医院心脏外科行先天性心脏病并非心脏畸形联合手术和单纯心脏手术患儿共72例。根据患儿病情严重程度将联合手术组(A组)和单纯心脏手术组(B组)分为低风险层(L层)和高风险层(H层)。A组患儿36例,年龄1.5~168.0个月(中位年龄18.0个月);B组患儿36例,年龄1.0~170.0个月(中位年龄19.0个月)。2组患儿术后返回心脏外科重症监护室(ICU)。记录各患儿体外循环(CPB)时间,主动脉阻断(ACC)时间,气管插管时间,ICU滞留时间,脑钠肽(BNP),丙氨酸转氨酶(ALT),肌酐(Cr)及入ICU即刻(T0)、术后4 h(T1)、8 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)等时刻的心排血指数(CI)、心脏循环效率(CCE)、最大压力梯度(dp/dt)、乳酸(Lac)、血糖(Glu)、正性肌力药物评分(IS)等。结果:1.A组组内比较:低风险层(L-A)患儿年龄[(39.9±37.0)个月]、身高[(94.1±20.1)cm]、体质量[(14.4±6.7)kg]均大于高风险层(H-A)患儿[(7.5±3.7)个月、(68.1±6.4)cm、(7.8±2.2)kg],差异均有统计学意义(均P<0.01);L-A组CPB时间[(37.0±23.6)min]、ACC时间[(19.1±13.4)min]、气管插管时间[(7.1±4.7)h]、ICU滞留时间[(1.1±0.3)d]、术后24 h BNP[(2257.3±952.0)ng/L]均小于H-A组[(84.7±28.4)min、(41.9±30.7)min、(71.0±67.6)h、(8.7±5.7)d、(5327.2±992.9)ng/L],差异均有统计学意义(均P<0.01);不同分层处理对Glu、IS、CI、CCE等参数的效应差异有统计学意义(均P<0.05),T0~T5时刻,L-A组的Glu(F=4.43,P<0.05)、IS(F=26.99,P<0.01)低于H-A组,CI(F=18.39,P<0.01)、CCE(F=5.28,P<0.05)高于H-A组。2.组间比较:分别在L层和H层中,A组与B组患儿年龄、身高、体质量、CPB时间、ACC时间、血流动力学参数、动脉血气参数、术后临床指标比较,差异均无统计学意义(均P>0.05)。结论:1.对于L层患儿,同期联合手术术后血流动力学稳定,Objective To explore the safety and feasibility of the simultaneous combined operation in children with congenital heart disease complicated with non-cardiac malformation.Methods A total of 72 children undergoing combined surgery or simple heart surgery in the Department of Cardiac Surgery,Children′s Hospital,Capital Institute of Pediatrics from January 2017 to January 2019 were enrolled.According to the severity of the disease,patients in the combined operation group(group A)and the simple heart surgery group(group B)were separately subdivided into the low risk group(group L)and the high risk group(group H).There were 36 children in group A,with the age ranging from 1.5 to 168.0 months old(median:18.0 months).There were 36 cases in group B,with the age ranging from 1.0 to 170.0 months old(median:19.0 months).Patients in groups A and B were sent to the cardiac intensive care unit(ICU)after operation.The cardiopulmonary bypass(CPB)time,aortic clamping(ACC)time,tracheal intubation time,intensive care unit(ICU)retention time,brain natriuretic peptide(BNP),alanine aminotransferase(ALT)and creatinine(Cr)were recorded.Besides,the cardiac output index(CI),cardiac circulation efficiency(CCE),maximum pressure gradient(dp/dt),lactic acid(Lac),blood glucose(Glu),inotropic score(IS)were also recorded at the time of returning to ICU(T0),4 hours after operation(T1),8 hours after operation(T2),12 hours after operation(T3),24 hours after operation(T4)and 48 hours after operation(T5),respectively.Results(1)Intra-group comparison in group A:the age[(39.9±37.0)months],height[(94.1±20.1)cm]and weight[(14.4±6.7)kg]of children at low risk(group L-A)were significantly higher than those at high risk(group H-A)[(7.5±3.7)months,(68.1±6.4)cm,(7.8±2.2)kg](all P<0.01).The CPB time[(37.0±23.6)min],ACC time[(19.1±13.4)min],endotracheal intubation time[(7.1±4.7)h],ICU retention time[(1.1±0.3)d]and BNP 24 hours after operation[(2257.3±952.0)ng/L]in group L-A were significantly lower than those in group H-A[(84.7±28.4)min,(41.9±30.

关 键 词：先天性心脏病 非心脏畸形 同期手术 

分 类 号：R726.5[医药卫生—儿科]