完全性肺静脉异位引流术后肺静脉狭窄的危险因素分析  

Risk factors for postoperative pulmonary venous obstruction after correction of total anomalous pulmonary venous connection

作　　者：毛俊[1] 许耀强[1] 李磊[1] 刘爱军[1] 陈焱[1] 贺彦[1] 范祥明[1] 刘迎龙[1] 苏俊武[1] Mao Jun;Xu Yaoqiang;Li Lei;Liu Aijun;Chen Yan;He Yan;Fan Xiangming;Liu Yinglong;Su Junwu(Department of Pediatric Cardiology,Capital Medical University Affiliated Beijing Anzhen Hospital,Being Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心,北京市心肺血管疾病研究所,100029

出　　处：《中华胸心血管外科杂志》2021年第11期669-672,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的分析完全性肺静脉异位引流术后肺静脉狭窄的危险因素。方法回顾性分析自2013年12月至2018年1月在北京安贞医院小儿心脏中心进行手术治疗的所有完全性肺静脉异位引流患儿,排除合并单心室、心房反位等复杂畸形。依据术后是否出现肺静脉狭窄,将患儿分为肺静脉狭窄组和无肺静脉狭窄组。比较两组患儿接受手术时的各项临床变量,将差异具有统计学意义的变量带入logistic回归模型进行多因素分析。结果入选患儿共145例,其中男91例(63%),女54例。患儿手术时中位年龄4(2,8)个月,中位体质量5.5(4.5,7.5)kg。术后随访(51±23)个月,27例(18.6%)出现肺静脉狭窄。术后出现肺静脉狭窄组与无肺静脉狭窄组相比,解剖分型[心上型18(67%)对59(50%),心内型4(15%)对50(42%),心下型3(11%)对1(1%),混合型2(7%)对8(7%),P=0.003]、术前有无肺静脉狭窄[有19(70%)对37(31%),无8(30%)对81(69%),P<0.001]、是否合并其他畸形[是13(48%)对27(23%),否14(52%)对91(77%),P=0.008]、体外循环[109(89,129)min对88(70,110)min,P=0.002]等变量的差异具有统计学意义。经多因素分析后显示术前存在肺静脉狭窄(P<0.001)及体外循环(P=0.009)为术后出现肺静脉狭窄的危险因素。结论完全性肺静脉异位引流术后肺静脉狭窄的发生率仍较高,尤其术前合并肺静脉狭窄,或术中体外循环过长,术后应加强随访,警惕肺静脉再狭窄的发生。Objective To analyze the risk factors for postoperative pulmonary venous obstruction after correction of total anomalous pulmonary venous connection(TAPVC).Methods We retrospectively reviewed all patients undergoing operative repair of TAPVC in our institution from December 2013 to January 2018.Patients with functionally univentricular circulations or atrial isomerism were excluded.Patients were divided into two groups according to whether there was pulmonary vein obstruction.The clinical variables of the two groups were compared.Variables for the multivariable analysis were chosen if there was statistical significance on univariable analysis.Results 145 patients were included,91(63%)males,aged 4(2,8)months and weight 5.5(4.5,7.5)kg.Mean follow-up interval was(51±23)months.Postoperative obstruction developed in 27 patients(18.6%).The differences of anatomic type[supracardiac 18(67%)vs.59(50%),cardiac 4(15%)vs.50(42%),infracardiac 3(11%)vs.1(1%),mixed 2(7%)vs.8(7%),P=0.003],preoperative obstruction[yes 19(70%)vs.37(31%),no 8(30%)vs.81(69%),P<0.001],associated cardiac lesions[yes 13(48%)vs.27(23%),no 14(52%)vs.91(77%),P=0.008]and bypass time[109(89,129)min vs.88(70,110)min,P=0.002]between two groups were statistical significant.A multivariable model showed preoperative obstruction(P<0.001)and bypass time(P=0.009)were associated with postoperative obstruction.Conclusion The incidence of pulmonary vein obstruction after correction of TAPVC was still high.If there was preoperative obstruction,or the bypass time was too long during operation,the surveillance of pulmonary vein obstruction should be strengthened after operation.

关 键 词：先天性心脏病 完全性肺静脉异位引流 肺静脉狭窄 危险因素 

分 类 号：R726.5[医药卫生—儿科]