低体重婴幼儿先天性室间隔缺损外科修补术后延迟恢复的风险因素分析  

Risk factors for deleyed recovery after surgical closure of congenital ventricular septal defect in infants with low weight

作　　者：李坤[1] 谌启辉[1] 王平凡[1] 白希玲[1] 贾湘杰 吴振宇[1] 宋峥[1] 闫丽伟[1] 王明伟 LI Kun;SHEN Qihui;WANG Pingfan;BAI Xiling;JIA Xiangjie;WU Zhenyu;SONG Zheng;YAN Liwei;WANG Mingwei(Department of Pediatric Heart Center,Henan Provincial Chest Hospital,Zhengzhou,450000,P.R.China)

机构地区：[1]河南省胸科医院小儿心脏中心,郑州450000

出　　处：《中国胸心血管外科临床杂志》2021年第1期64-69,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨体重≤5.0 kg的低体重婴幼儿行室间隔缺损修补术延迟恢复及并发症的风险因素。方法回顾性分析2016年1月至2019年7月在我院接受室间隔缺损修补术且体重≤5.0 kg 86例患者的临床资料,其中男31例、女55例,年龄17~266(80.3±40.4)d,体重2.5~5.0(4.4±0.6)kg。室间隔缺损分类:膜周部室间隔缺损65例(75.6%),干下型室间隔缺损17例(19.8%),干下+肌部室间隔缺损4例(4.7%)。术后延迟恢复定义为机械辅助通气时间≥24 h或住ICU时间≥72 h。主要不良事件包括:死亡、心脏骤停、完全性房室传导阻滞(一过性或永久性)、神经系统并发症、因残余分流或瓣膜反流的二次手术、二次插管、膈肌麻痹等临床并发症。结果全组患者无围术期死亡。51例患者呼吸机使用时间≥24 h,51例患者住ICU时间≥72 h。无因残余分流再次手术者,无神经系统并发症者。6例(7.0%)术后二次气管插管,2例(2.3%)出现一过性房室传导阻滞而应用心脏表面临时起搏器。术后随访时间3~36(15.8±8.8)个月,随访期间死亡1例,左心室收缩功能降低1例,5例三尖瓣少量反流,无主动脉瓣损伤。结论低体重婴幼儿的先天性室间隔缺损修补术近期结果满意,但低体重、低年龄可能导致患者术后呼吸机使用时间过长;低出生体重、术前合并肺动脉高压可能导致术后住ICU时间过长,但并非独立危险因素。Objective To reveal the risk factors for delayed recovery and complications in infants with weight≤5.0 kg after surgical ventricular septal defect(VSD)closure.Methods We retrospectively reviewed a consecutive series of86 patients with weight≤5.0 kg who were admitted to our institution for surgical VSD closure between January 2016 and July 2019,including 31 males and 55 females with an age of 17-266(80.3±40.4)d and a weight of 2.5-5.0(4.4±0.6)kg.The VSDs were divided into perimembranous(n=65,75.6%),subaortic(n=17,19.8%)and subaortic combined muscular types(n=4,4.7%).Mechanical ventilation(MV)time≥24 h or ICU stay≥72 h were defined as delayed recovery.Death,sudden circulatory arrest,complete heart block requiring a permanent or temporary pacemaker implantation,neurological complications,reoperation(for residue shunt or valvular regurgitation),reintubation and diaphragmatic paralysis were considered as significant major adverse events.Results There was no death,reoperation due to residual VSD or neurological complication.Totally 51(59.3%)patients had MV timec≥24 h and 51(59.3%)patients stayed in the ICU≥72 h.Two(2.3%)patients required temporary pacemaker and six(7.0%)patients required reintubation.During the followup of 3-36(15.8±8.8)months,1 patient died of pneumonia after discharge,5 patients suffered mild tricuspid valve regurgitation and 1 patient suffered decreased left ventricular systolic function in the follow-up.No aortic valve injuries occurred.Conclusion For patients whose weight≤5.0 kg,short-term results of surgical VSD closure are excellent.Low weight and age may prolong MV time;low birth weight and pulmonary hypertension may prolong ICU stay,but are not independent risk factors.

关 键 词：先天性心脏病 室间隔缺损 低体重 手术 

分 类 号：R726.5[医药卫生—儿科]