5 kg以下先天性心脏病患儿行体外循环心脏手术后死亡危险因素分析  

Analysis of risk factors of death after cardiopulmonary bypass in children with congenital heart disease less than 5 kg

作　　者：杨景娟 段维勋 李艳艳 Yang Jingjuan;Duan Weixun;Li Yanyan(Department of Cardiac Surgery,The First Affiliated Hospital of Air Force Military Medical University,Xi'an 710000,China;Department of General Diagnosis and Treatment,The First Affiliated Hospital of Air Force Military Medical University,Xi'an 710000,China)

机构地区：[1]空军军医大学第一附属医院心外科,西安710032 [2]空军军医大学第一附属医院综合诊疗科,西安710032

出　　处：《中国综合临床》2022年第1期73-78,共6页Clinical Medicine of China

基　　金：国家重点研发计划基金项目(2016YFC1301904)。

摘　　要：目的探讨体外循环下行心脏手术的5 kg以下先天性心脏病(congenital heart disease,CHD)患儿手术死亡的相关危险因素。方法收集2017年2月至2020年2月在空军军医大学第一附属医院行体外循环开放手术的CHD患儿225例的临床资料,进行回顾性病例对照研究。计量资料两组间比较采用独立样本t检验,计数资料组间比较采用χ^(2)检验或χ^(2)校正检验,等级分布资料组间采用Mann-Whitney秩和检验,影响CHD患儿手术死亡的因素采用多因素Logistic回归分析。结果225例患儿手术存活204例(90.67%,204/225),死亡21例(9.33%,21/225)。单因素分析结果显示,死亡组患儿年龄(2.48±0.68)月、体质量(2.28±0.56)kg明显低于存活组患儿年龄(4.92±0.65)月(t=16.33,P<0.001)、体质量(4.26±0.52)kg(t=16.38,P<0.001);而女性比例[66.67%(14/21)];营养不良比例[无:14.28%(3/21)、轻度:42.86%(9/21)、重度:42.86%(9/21)];姑息性手术比例[28.57%(6/21)];根治性手术比例[71.43%(15/21)];CHD手术的风险调整-1(risk adjustment for surgery for congenital heart disease-1,RACHS-1)分级比例[<3级:23.81%(5/21)、≥3级:76.19%(16/21)];体外循环时间(135.24±11.19)min;主动脉阻断时间(78.24±8.20)min;手术时间(178.43±13.82)min;心脏畸形复杂比例[复杂:47.62%(10/21)、简单:52.38%(11/21)];ICU治疗时间(4.76±0.77)d;术后机械通气时间(121.33±12.66)h明显高于存活组患儿女性比例[41.67%(85/204),χ^(2)=4.83,P=0.028];营养不良比例[无:38.24%(78/204)、轻度:42.15%(86/204)、重度:19.61%(40/204),z=2.72,P=0.007];姑息性手术比例8.82%(18/204);根治性手术比例91.18%(186/204)(校正χ^(2)=5.86,P=0.016);RACHS-1分级比例[<3级:77.45%(158/204)、≥3级:22.55%(46/204),χ^(2)=27.44,P<0.001];体外循环时间(106.87±11.12)min(t=11.12,P<0.001);主动脉阻断时间(58.68±9.26)min(t=9.32,P<0.001);手术时间(167.24±13.75)min(t=3.55,P<0.001);心脏畸形复杂比例[复杂:78.92%(161/204)、简单:21.08%(43/204)(χ^(2)=10.23,P<0.001)];ICU治�Objective To investigate the risk factors for surgical death in children with congenital heart disease(CHD)less than 5 kg undergoing cardiopulmonary bypass.Methods The clinical data of 225 children with CHD who underwent open cardiopulmonary bypass in the First Affiliated Hospital of Air Force Military Medical University from February 2017 to February 2020 were collected for a retrospective case-control study.The independent sample T test was used for inter-group comparison of measurement data,Chi square test or chi squre correction test was used for the comparision between count data.Mann-Whitney rank-sum test was used for rank distribution data and multiple Logistic regression analysis was performed for factors affecting surgical death of children with CHD.Results Among the 225 cases,204(90.67%,204/225)survived surgery and 21(9.33%,21/225)died.Univariate analysis showed that age(2.48±0.68)months and body weight(2.28±0.56)kg in the death group were significantly lower than that in the survival group(4.92±0.65)months(t=16.33,P<0.001)and body weight(4.26±0.52)kg(t=16.38,P<0.001),while the proportion of female(66.67%(14/21)),malnutrition(none:14.28%(3/21);Mild:42.86%(9/21).Severity:42.86%(9/21)),palliative surgery proportion(28.57%(6/21)),emergency surgery proportion(71.43%(15/21)),congenital heart surgery risk assessment(RACHS-1)grading ratio(<grade 3:23.81%(5/21),≥grade 3:76.19%(16/21)),CPB time(135.24±11.19)min,aorta blocking time(78.24±8.20)min,operation time(178.43±13.82)min,heart malformation complex ratio(complex:47.62%(10/21),simple:52.38%(11/21)),ICU treatment days(4.76±0.77)d,postoperative mechanical ventilation time(121.33±12.66)h were significantly higher than the female survival group(41.67%(85/204),χ^(2)=4.83,P=0.028),malnutrition rate(none:38.24%(78/204);Mild:42.15%(86/204));Severe:19.61%(40/204)(z=2.72,P=0.007),palliative surgery proportion 8.82%(18/204),proportion of radicalsurgery91.18%(186/204)(χ^(2)=5.86,P=0.016),RACHS-1 grading ratio(<grade 3:77.45%(158/204);≥grade 3:22.55%(46/20

关 键 词：先天性心脏病 体外循环心脏手术 低体质量 手术死亡 危险因素 

分 类 号：R726.5[医药卫生—儿科]