小婴儿先天性心脏病手术早期预后的相关因素:单中心511例经验总结  

Clinical factors affecting the early postoperative prognosis of infants suffering surgery for congenital heart diseases:A single-center experience of 511 patients

作　　者：卢婷[1,2] 钱涛 唐轶伦 袁浩泳 毛幸 黄灿 吴忠仕[1,2,3] LU Ting;QIAN Tao;TANG Yilun;YUAN Haoyong;MAO Xing;HUANG Can;WU Zhongshi(Department of Cardiovascular Surgery,Second Xiangya Hospital,Central South University,Changsha 410011;Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials,Changsha 410011;National Health Commission Key Laboratory of Birth Defects Research,Prevention,and Treatment,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院心血管外科,长沙410011 [2]心血管用生物工程材料湖南省工程实验室,长沙410011 [3]国家卫生健康委员会出生缺陷研究与预防重点实验室,长沙410011

出　　处：《中南大学学报（医学版）》2022年第1期86-93,共8页Journal of Central South University ：Medical Science

基　　金：湖南省科技重大专项(2019SK1010);湖南省卫生健康委科研项目(202104020916)。

摘　　要：目的:随着先天性心脏病(congenital heart disease,CHD)产前产后诊疗一体化工作的开展,小婴儿手术患者逐年增多。本研究旨在回顾性总结中南大学湘雅二医院心血管外科开展CHD产前咨询以来,3月龄内小婴儿CHD外科治疗的早期预后情况,探讨术后死亡和延迟恢复的危险因素。方法:通过查阅电子病历系统收集患儿临床资料。延迟恢复定义为术后呼吸机辅助时间、心脏重症监护室(cardiac intensive cure unit,CICU)滞留时间、术后住院时间中任一指标超过全组第3四分位数。采用多因素logistic回归分析探讨死亡及延迟恢复相关危险因素及比值比(odds ratio,OR)。结果:2016年1月至2020年6月共511例诊断为CHD的小婴儿于中南大学湘雅二医院行外科治疗,其中217例(42.5%)为复杂CHD。手术中位年龄60 d(3 h~90 d),中位体重4.5(1.7~8.4)kg。住院期死亡26例,总死亡率5.1%。其中,预后风险评分≤2的患儿死亡5例(5/294,1.7%),复杂CHD患儿死亡21例(21/217,9.7%)。多因素logistics回归分析显示复杂CHD(OR=5.53,P<0.001)、体重<4.0 kg(OR=9.86,P<0.001)、术前有症状(OR=3.17,P=0.012)、急诊手术(OR=11.66,P<0.001)为住院期死亡的危险因素。术后呼吸机辅助、CICU滞留、术后住院天数的中位时间分别为21.0(0.3~979.0)h、3.0(0.5~91.0)d、11.5(3.0~105.0)d,其中177例(34.6%)患儿延迟恢复。多因素logistics回归分析显示复杂CHD(OR=3.41,P=0.001)、体重<4.0 kg(OR=4.55,P<0.001)、术前有症状(OR=3.91,P<0.001)为术后延迟恢复的危险因素。结论:3月龄内小婴儿CHD手术死亡率偏高,特别是复杂CHD患儿与<4.0 kg的低体重患儿。建立产前产后诊治一体化管理模式可准确把握手术时机,避免术前出现症状,减少急诊手术比例,改善小婴儿CHD外科治疗的早期预后。Objective:The integrated model of prenatal diagnosis and postnatal treatment for congenital heart disease(CHD)leads to an increasing number of operation in infants.This study aims to reveal the risk factors for postoperative early mortality and delayed recovery in infants less than 3 months old,who underwent surgical treatment for CHD in the Department of Cardiovascular Surgery,Second Xiangya Hospital,Central South University during the past 5 years.Methods:Clinical variables were collected via medical records.Delayed recovery was defined as the time of postoperative intubation,or cardiac intensive cure unit(CICU)stay,or hospital stay longer than its third quartile.Risk factors for early postoperative prognosis and the odds ratio(OR)were analyzed with logistic regression analysis.Results:A total of 511 infants underwent surgical treatment for CHD from January 2016 to June 2020 were retrospectively reviewed,including 217(42.5%)infants with complex CHD.The median age was 60 days(3 hours-90 days);and median weight was 4.5(1.7-8.4 kg).There were 26 postoperative mortalities,making the incidence at 5.1%,including 5(5/294,0.7%)mortalities in patients with uncomplicated CHD,and 21(9.6%)mortalities in patients with complex CHD.Based on multivariable analysis,risk factors for postoperative mortality were diagnosis of complex CHD(OR=5.53,P<0.001),weight under 4.0 kg(OR=9.86,P<0.001),preoperative symptoms(OR=3.17,P=0.012),and emergency operation(OR=11.66,P<0.001).The median time for postoperative intubation,CICU stay,and hospital stay were 21.0(0.3-979.0)hours,3.0(0.5-91.0)days,and 11.5(3.0-105.0)days,respectively.A total of 177(34.6%)infants delayed recover,with risk factors including diagnosis of complex CHD(OR=3.41,P=0.001),weight under 4.0 kg(OR=4.55,P<0.001),and preoperative symptoms(OR=3.91,P<0.001).Conclusion:Surgical treatment for infants(<3 months)with CHD is still a challenge,particularly for infants with complex CHD and weight under 4.0 kg.We can improve the prognosis of CHD treatment in infants by establishing t

关 键 词：先天性心脏病 小婴儿 低体重 外科治疗 产前产后诊治一体化 

分 类 号：R726.5[医药卫生—儿科]