先天性心脏病术后早期并发心动过速的诊断及治疗经验  

Diagnosis and treatment of early postoperative tachycardia in patients with congenital heart disease

作　　者：谢业伟[1] 李佳[1] 张儒舫[1] Xie Yewei;Li Jia;Zhang Rufang(Department of Cardiothoracic Surgery,Shanghai Children's Hospital&Children's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院上海交通大学附属儿童医院心胸外科,200062

出　　处：《中国综合临床》2021年第6期536-540,共5页Clinical Medicine of China

基　　金：上海市科学技术委员会科技支撑项目(17411969000)。

摘　　要：目的分析与明确先天性心脏病患儿术后早期并发心动过速的原因、类型、风险因素及治疗原则。方法回顾性分析2014年1月至2020年12月上海市儿童医院完成先天性心脏病一期根治手术、符合临床研究指标且有记录值的2126例的临床资料,其中包括室间隔缺损或室间隔缺损+房间隔缺损,合计1322例,房间隔缺损421例,法洛四联症、完全大动脉转位或右心室双出口伴肺动脉狭窄等共计194例、其他复杂先天性心脏病如完全性房室通道、完全性肺静脉异位引流等共计189例。手术方法是胸骨正中皮肤切口或右侧腋下皮肤小切口,常规建立体外循环。观察与监测患儿年龄、体质量、疾病类型、体外循环及主动脉阻断时间、血管活性药物使用、心电图监测等指标。结果2126例先天性心脏病患儿术后早期并发的心动过速425例,发生率20.0%。窦性心动过速、交界性异位心动过速、房性心动过速、室性心动过速发生率分别为14.8%(314/2126)、4.5%(96/2126)、0.8%(17/2126)、0.5%(10/2126)。单因素及多因素Logistic回归分析显示,先天性心脏病患儿术后早期出现心动过速与患儿低龄(OR=1.98,95%CI:1.25~2.65,P<0.01)、低体质量(OR=2.35,95%CI:1.86~2.75,P<0.01)、大型室间隔缺损(OR=1.56,95%CI:1.09~2.06,P=0.02)、复杂先天性心脏病(OR=2.03,95%CI:1.57~2.52,P<0.01)、较长体外循环时间(OR=1.77,95%CI:1.23~2.28,P<0.01)及主动脉阻断时间(OR=1.89,95%CI:1.20~2.55,P<0.01)、酸中毒(OR=1.63,95%CI:1.11~2.14,P<0.01)、血管活性药物如多巴胺及肾上腺素联合使用(OR=1.86,95%CI:1.23~2.48,P<0.01)密切相关。结论预判先天性心脏病患儿术后早期出现的心动过速,明确其原因及类型并及时处理,从而提高术后患儿生存率具有重要临床指导价值。Objective To analyze and clarify the causes,types,risk factors and treatment principles of early postoperative tachycardia in children with congenital heart disease.Methods A retrospective analysis of the clinical data of 2126 children with primary radical congenital heart surgical procedure in Shanghai Children′s Hospital from January 2014 to December 2020,including 1322 cases of ventricular septal defect or ventricular septal defect combined with atrial septal defect,421 cases of atrial septal defect,194 cases of tetralogy of Fallot,D-transposition of the great artery or double outlets of right ventricle combined with pulmonary stenosis,and 189 cases of other complex congenital heart disease.The surgical method is a median sternal skin incision or a small right axillary skin incision,and cardiopulmonary bypass is established routinely.The age,body mass,disease type,cardiopulmonary bypass and aortic occlusion time,vasoactive drug use,ECG monitoring and other indexes were observed and monitored.Results There are 425 cases of early postoperative tachycardia in 2126 children with congenital heart disease,with an incidence of 20.0%.The incidences of sinus tachycardia,borderline ectopic tachycardia,atrial tachycardia and ventricular tachycardia were 14.8%(314/2126),4.5%(96/2126),0.8%(17/2126)and 0.5%(10/2126),respectively.Logistic regression analysis revealed that the low age(OR=1.98,95%CI:1.25-2.65,P<0.01),low weight(OR=2.35,95%CI:1.86-2.75,P<0.01),large ventricular septal defect(OR=1.56,95%CI:1.09-2.06,P=0.02),complex congenital heart disease(OR=2.03,95%CI:1.57-2.52,P<0.01),long duration of cardiopulmonary bypass(OR=1.77,95%CI:1.23-2.28,P<0.01),long aortic cross-clamp time(OR=1.89,95%CI:1.20-2.55,P<0.01),acidosis(OR=1.63,95%CI:1.11-2.14,P<0.01),and the combination usage of vasoactive drugs(OR=1.86,95%CI:1.23-2.48,P<0.01)were significantly associated with the occurrence of early postoperative tachycardias.Conclusion This study has important clinical guiding value for predicting early postoperative tachycardia in c

关 键 词：心动过速 先天性心脏病术后早期 病因分析 风险因素 

分 类 号：R726.5[医药卫生—儿科]