826例复杂型先天性心脏病患儿治疗及预后的单中心回顾性研究  

Treatment and prognosis of 826 infants with critical congenital heart disease:a single center retrospective study

作　　者：张晓晖 何少茹[1] 刘玉梅[1] 庄健[1] 陈寄梅[1] 钟劲[1] 孙云霞[1] 郑曼利[1] 桂娟 冯博文 莫剑玲 简敏桥 Zhang Xiaohui;He Shaoru;Liu Yumei;Zhuang Jian;Chen Jimei;Zhong Jin;Sun Yunxia;Zheng Manli;Gui Juan;Feng Bowen;Mo Jianling;Jian Minqiao(Department of Neonatal Intensive Care Unit,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Neonatal Intensive Care Unit,Guangdong Provincial Peopled Hospital Affiliated to South China University of Technology,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所,广东省人民医院(广东省医学科学院)新生儿科,广州510080 [2]华南理工大学附属广东省人民医院新生儿科,广州510080

出　　处：《中华心血管病杂志》2021年第11期1102-1107,共6页Chinese Journal of Cardiology

基　　金：国家重点研发计划项目(2018YFC1002600);国家自然科学基金(81671529)。

摘　　要：目的分析复杂型先天性心脏病(CCHD)患儿的临床诊疗现状及术后死亡的影响因素,优化CCHD的围术期管理,为临床决策提供新的科学依据。方法本研究为回顾性单中心研究。入选2017年1月到2019年12月在广东省人民医院诊断为CCHD的婴儿(入院时年龄为0~1岁)。收集患儿的一般临床信息、住院诊疗资料、预后及并发症等。选取接受手术治疗的患儿,采用多因素logistic回归分析探索影响接受手术治疗的CCHD患儿术后死亡的独立危险因素。结果共纳入826例CCHD患儿,其中男婴556例(67.3%),首次入院年龄为51.0(5.0,178.3)d。法洛四联症264例(32.0%)和完全性肺静脉回流异常137例(16.6%)占多数。产前诊断者195例(23.6%)。196例(23.7%)患儿使用前列腺素治疗。术前有创通气时间0(0,0)h,术后有创通气时间95.0(26.0,151.8)h。668例(80.9%)接受了手术治疗,手术时年龄100.5(20.0,218.0)d,手术时间190.0(155.0,240.0)min。62例(7.5%)接受内科治疗,96例(11.6%)放弃治疗。675例(81.7%)好转出院,55例(6.7%)死亡,109例(13.2%)在1年内再次入院。出现并发症的患儿有565例(68.4%),主要为肺炎334例(40.4%)和心律失常182例(22.0%)。多因素logistic回归分析结果显示,延迟关胸(OR=49.775,95%CI 3.291~752.922,P=0.005)、术后有创呼吸机通气时间延长(OR=1.003,95%CI 1.000~1.005,P=0.038)和心脏低排综合征(OR=272.658,95%CI 37.861~1963.589,P<0.001)是CCHD患儿术后死亡的独立危险因素。结论CCHD患儿中多数为法洛四联症和完全性肺静脉回流异常,产前诊断者不到1/4,多数接受了手术治疗。并发症主要以肺炎和心律失常多见。延迟关胸、术后有创呼吸机通气时间延长和心脏低排综合征是CCHD患儿术后死亡的独立危险因素。Objective To analyze the current status of clinical treatment and factors influencing postoperative mortality in infants with critical congenital heart disease(CCHD)in China,optimize the perioperative management of CCHD,and provide a new scientific basis for clinical decision-making for the optimal management of these patients.Methods This is a retrospective single-center study.Infants diagnosed with CCHD in Guangdong Provincial People′s Hospital from January 2017 to December 2019(aged 0-1 years at admission)were enrolled.General clinical information,inpatient treatment information,prognosis and complications were collected and analyzed.Multivariate logistic regression analysis was used to explore the independent risk factors of postoperative death in infants with CCHD.Results A total of 826 infants with CCHD were included,including 556 males(67.3%)and the age at first admission was 51.0(5.0,178.3)days.264(32.0%)cases were tetralogy of Fallot and 137(16.6%)cases were total anomalous pulmonary venous return.195 cases(23.6%)were diagnosed prenatally.196 cases(23.7%)were treated with prostaglandin.The preoperative invasive ventilation time was 0(0,0)hour,and the postoperative invasive ventilation time was 95.0(26.0,151.8)hours.A total of 668 cases(80.9%)underwent surgical treatment.The age was 100.5(20.0,218.0)days during operation and the operation time was 190.0(155.0,240.0)hours.Sixty-two cases(7.5%)received medical treatment,and 96 cases(11.6%)gave up treatment.A total of 675 cases(81.7%)were discharged with improvement,96 cases(11.6%)were discharged after giving up treatment,55 cases(6.7%)died and 109 cases(13.2%)were readmitted within one year.Complications occurred in 565(68.6%)cases,including pneumonia in 334 cases(40.4%)and cardiac arrhythmias in 182 cases(22.0%).Multifactorial analysis showed that delayed chest closure(OR=49.775,95%CI 3.291-752.922,P=0.005),prolonged post-operative invasive ventilator ventilation(OR=1.003,95%CI 1.000-1.005,P=0.038)and cardiac hypoplasia syndrome(OR=272.658,95%CI 37.861-1

关 键 词：复杂型先天性心脏病 法洛四联症 延迟关胸 低排综合征 有创通气 临床决策 产前诊断 住院诊疗 

分 类 号：R725.4[医药卫生—儿科]