儿童室间隔缺损介入术后并发严重溶血的危险因素分析  

Analysis on risk factors of complicating severe hemolysis after intervention operation in child ventricular septal defect

作　　者：陈永茜 李谧[1] 易岂建[1] 吴晓云[2] 冯川[3] 卢思 向平[1] CHEN Yongxi;LI Mi;YI Qijian;WU Xiaoyun;FENG Chuan;LU Si;XIANG Ping(Department of Cardiology,Affiliated Children′s Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China;Department of Echocardiography,Affiliated Children′s Hospital of Chongqing Medical University,Chongqing 400014,China;Department of Radiology,Affiliated Children′s Hospital of Chongqing Medical University,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院心血管内科/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室,重庆400014 [2]重庆医科大学附属儿童医院超声科,重庆400014 [3]重庆医科大学附属儿童医院放射科,重庆400014

出　　处：《重庆医学》2020年第24期4172-4175,共4页Chongqing medicine

摘　　要：目的探讨儿童室间隔缺损(VSD)介入术后并发严重溶血的危险因素。方法收集该院2009年8月至2018年7月VSD介入术后发生严重溶血的患者,分析严重溶血发生的原因、处理及预后。结果共收集VSD介入术治疗患儿1088例,其中发生严重溶血13例中,发生率1.19%。13例患儿,男5例,女8例,月龄12~85个月,平均(41.2±20.2)个月,体重10~20 kg,平均(14.5±3.2)kg。VSD直径为3.0~15.0 mm,平均(8.0±4.1)mm,选择封堵器直径为6~18 mm,平均(9.9±3.9)mm,其中10例为对称型封堵器,3例为非对称型封堵器。所有患儿术后均有不同程度肉眼血尿,尿隐血阳性(++^+++),伴血红蛋白下降,患儿术前血红蛋白110~142 g/L,平均(124.5±9.0)g/L,术后血红蛋白67~119 g/L,平均(100.8±15.0)g/L,所有溶血均发生在术后48 h内。11例予内科保守治疗后好转出院,2例转外科手术取出封堵器。行多因素logistic回归分析发现,超声下直径大小、封堵器直径大小、主肺动脉压力大小、膜部瘤、使用非对称的封堵器是儿童VSD介入术后并发严重溶血的危险因素,术后残余分流、中度以上瓣膜反流与儿童VSD介入术后并发严重溶血可能有关。结论儿童VSD介入术后严重溶血与多种因素有关。Objective To investigate the risk factors of complicating severe hemolysis after intervention operation in child ventricular septal defect(VSD).Methods The cases of severe hemolysis after VSD interventional operation in this hospital from August 2009 to July 2018 were collected to analyze the causes,treatment and prognosis of severe hemolysis occurrence.Results A total of 1088 cases of VSD interventional operation were collected,among them 13 cases developed severe hemolysis with an incidence rate of 1.19%.The 13 cases included 5 males and 8 females,with the month age of 12-85(41.2±20.2)months and body weigh of 10-20(14.5±3.2)kg.The diameter of VSD was 3.0-15.0(8.0±4.1)mm,and the diameter of selected occluders was 6-18(9.9±3.9)mm,in which 10 cases were the symmetrical occluders.All the cases had different degrees of gross hematuria and the urine occult blood was positive(++-+++),accompanied by hemoglobin decrease.The preoperative hemoglobin was 110-142(124.5±9.0)g/L,postoperative hemoglobin was 67-119(100.8±15.0)g/L and all hemolysis occurred within postoperative 48 h.Eleven cases were improved and discharged after conservative medical treatment,and 2 cases were transferred to surgery for removing the occluders.The multivarate logistic regression analysis found that the VSD diameter under ultrasound,diameter of occluders,pressure of main pulmonary artery,membrane tumor and use of asymmetric occluders were the risk factors of severe hemolysis occurrence after VSD intervention operation.The postoperative residual shunt and moderate or above valvular regurgitation could be related to complicating severe hemolysis after child VSD intervention operation.Conclusion Severe hemolysis after child VSD intervention operation is associated with a variety of factors.

关 键 词：室间隔缺损 介入封堵术 溶血 儿童 危险因素 

分 类 号：R725.4[医药卫生—儿科]