儿童先天性心脏病术后行膈肌折叠手术的临床观察研究  

Clinical observation of diaphragm plication after pediatric congenital heart disease surgery

作　　者：刘佳琪 陈曦[1] 张明杰[1] 王丽平[1] 庞亚昌 徐卓明[1] Liu Jiaqi;Chen Xi;Zhang Mingjie;Wang Liping;Pang Yachang;Xu Zhuoming(Department of Cardiovascular and Thoracic Surgery,Shanghai Children′s Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学附属上海儿童医学中心心胸外科,200127

出　　处：《中国小儿急救医学》2022年第1期40-44,共5页Chinese Pediatric Emergency Medicine

基　　金：国家自然科学基金(81771934);上海交通大学"交大之星"计划医工交叉研究基金(YG2019ZDA03)。

摘　　要：目的分析儿童先天性心脏病(CHD)术后行膈肌折叠术(DPL)的危险因素、时机和临床疗效。方法回顾性分析2017年1月至2019年12月在上海儿童医学中心行CHD手术患儿的临床资料,根据CHD术后是否行DPL分为DPL组和未行膈肌折叠术组(NDPL组),比较两组患儿年龄、CHD术式、术次、体外循环(CPB)时间等临床资料。以CHD手术与DPL间隔时间中位数8 d,将DPL组患儿分为早期手术组(间隔时间<8 d),及延迟手术组(间隔时间≥8 d),比较两组患儿呼吸机使用时间、住院时间、住院花费、术后感染等临床资料。结果共收入CHD术后患儿10309例,DPL组95例,NDPL组10214例。DPL组中男52例(54.7%)、女43例(45.3%),年龄147(52,318)d,体重(5.5±4.1)kg,身高(56.8±25.6)cm,CPB时间(136.8±93.4)min,主动脉阻断时间(62.5±50.2)min。与NDPL组比较,DPL组患儿年龄小、身高矮、体重轻、术前特殊处理发生率高、再次手术比例高、CPB温度低、CPB时间长、主动脉阻断时间长,两组间差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,年龄(OR=0.998,95%CI 0.998~0.999,P<0.001)、分期手术(OR=72.977,95%CI 39.096~136.211,P<0.001)、长CPB时间(OR=1.006,95%CI 1.002~1.011,P=0.008)、肺静脉成形术(OR=4.219,95%CI 2.132~8.350,P<0.001)是CHD术后膈肌功能障碍行DPL的独立危险因素。早期手术组较延迟手术组术后感染率低(43.59%比88.38%,P=0.007)、机械通气时间短[168.0(99.5,280.5)h比309.9(166.2,644.5)h,P=0.029]、住院时间短[27.00(20.75,35.00)d比37.00(28.00,53.00)d,P<0.001]、住院花费少[158.36(128.99,203.11)千元比232.95(174.54,316.47)千元,P<0.001]。结论小手术年龄、分期手术、较长CPB时间、肺静脉成形术是CHD术后膈肌功能障碍行膈肌折叠的独立危险因素,早期手术干预有益于患儿恢复。Objective To analyze the risk factors of performing diaphragm plication(DPL)after congenital heart disease(CHD)surgery as well as the timing and clinical efficacy.Methods Data regarding children underwent open heart surgery at Shanghai Children′s Medical Center from January 2017 to December 2019 were reviewed.According to whether DPL was performed after CHD operation or not,the children were divided into DPL group and non-diaphragm plication(NDPL)group.Clinical data including age,surgery,cardiopulmonary bypass(CPB)temperature and time of two groups were compared,meanwhile the risk factors of DPL surgery were analyzed.Based on the median of 8 days between open heart surgery and DPL,children in DPL group were divided into early surgery group(less than 8 days),and delayed operation group(no less than 8 days).The parameters of comparison included ventilator using time,hospital stay time,hospitalization expenditure,postoperative infection to evaluate the timing of DPL and effect.Results There were 10309 children after CHD,including 95 in DPL group and 10214 in NDPL group.In DPL group,there were 52 males(54.7%)and 43 females(45.3%),with age 147(52,318)d,weight(5.5±4.1)kg,height(56.8±25.6)cm,CPB time(136.8±93.4)min and aortic occlusion time(62.5±50.2)min.Compared with NDPL group,DPL group had younger age,shorter height,lighter weight,higher incidence of preoperative special treatment,higher proportion of reoperation,lower CPB temperature,longer CPB time and longer aortic occlusion time.There were significant differences between two groups(P<0.05).Multivariate Logistic regression analysis showed that younger operative age(OR=0.998,95%CI 0.998~0.999,P<0.001),staging operation(OR=72.977,95%CI 39.096~136.211,P<0.001),long CPB time(OR=1.006,95%CI 1.002~1.011,P=0.008),and pulmonary venoplasty(OR=4.219,95%CI 2.132~8.350,P<0.001)were independent risk factors for DPL after CHD.Early surgery group had lower postoperative infection rate(43.59%vs.88.38%,P=0.007),shorter ventilator duration[168.0(99.5,280.5)h vs.309.9(166.2,64

关 键 词：先天性心脏病 膈肌折叠 危险因素 干预时机 

分 类 号：R726.5[医药卫生—儿科]