新生儿及小婴儿复杂先天性心脏病手术后早期拔除气管插管的影响因素分析  

Influencing factors for early extubation in neonates and young infants following surgical repair of complex congenital heart disease

作　　者：曾敏[1,3] 李胜利[1] 段雷雷[1] 李守军[2] 闫军[2] 花中东[2] 王旭[1,3] Zeng Min;Li Shengli;Duan Leilei;Li Shoujun;Yan Jun;Hua Zhongdong;Wang Xu(PICU,Pediatric Cardiac Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China;Department of Cardiac Surgery,Pediatric Cardiac Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China;Pediatric Cardiology Section,Pediatric Cardiac Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院小儿心脏中心儿童重症监护室,北京100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院小儿心脏中心外科,北京100037 [3]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院小儿心脏中心内科,北京100037

出　　处：《临床小儿外科杂志》2022年第4期364-369,共6页Journal of Clinical Pediatric Surgery

基　　金：北京协和医学院教育教学改革项目(10023201800203);“十三五”国家重点研发计划项目(2017YFC1308100)。

摘　　要：目的本研究旨在分析新生儿和小婴儿先天性心脏病(congenital heart surgery,CHD)手术后早期拔除气管插管(early extuabtion,EE)的临床结果,探讨新生儿及小婴儿CHD手术后EE的可行性及影响因素。方法以2017年1月1日至2019年12月31日由中国医学科学院阜外医院收治的391例新生儿和小婴儿CHD患者作为研究对象,根据手术后撤离呼吸机的时间,将患者分为EE组(术后24 h内拔除气管内插管)和非EE组(术后超过24 h拔除气管内插管),分析EE的影响因素,比较EE组和非EE组患儿的并发症及预后。结果单因素分析发现,年龄、体重、主动脉阻断时间(aortic cross clamp,ACC)、体外循环时间(cardiopulmonary bypass,CPB)、RACHS-1风险分级以及BT分流术是EE的影响因素。进一步行多因素Logistic回归分析发现,低体重(OR=0.648,95%CI:0.471~0.893)和BT分流术(OR=0.109,95%CI:0.013~0.934)是EE的独立影响因素。本研究中总病死率2.3%(9/391)。EE人数占比为65.0%,EE组无死亡。新生儿136例(136/391,34.9%)中行EE者人数比率为58.8%(80/136)。EE组呼吸机辅助呼吸时间、ICU住院时间低于非EE组,差异有统计学意义(P<0.001)。两组术后并发症比较,EE组二次气管插管比率[3.15%(8/254)比12.4%(17/137)]和术后感染比率[1.18%(3/254)比14.6%(20/137)]较非EE组低,差异有统计学意义(P<0.05)。结论大多数新生儿和小婴儿复杂CHD手术后可以实现EE,行EE的患儿ICU住院时间、呼吸机辅助通气时间缩短,术后感染率降低。低体重儿和BT分流术是影响新生儿和小婴儿复杂CHD手术后EE的独立影响因素。Objective To analyze the clinical outcomes and to explore the feasibility and influencing factors of early extubation(EE)in neonates and young infants after congenital heart disease(CHD)repair.Methods We conducted a retrospective analysis of neonate and young infants with CHD who underwent cardiac surgery at Fuwai Hospital between January 1,2017,and December 31,2019.A total of 391 patients were included.According to the mechanical ventilator time(MVT)after admitted to the PICU,patients were divided into two groups:EE group(MVT<24 h)and nonEE group(MVT>24 h).Univariate and multivariate analysis was used to identify the risk factors for EE.Complications and clinical outcomes were compared between the EE group and the nonEE group.Results In univariate analysis,the significantly differences were found in age,weight,ACC time,CPB time,and RACHS-1.Multivariate logistic regression analysis indicated that low weight(OR=0.648,95%CI:0.471~0.893)and BT procedure(OR=0.109,95%CI:0.013~0.934)were independent risk factors for EE.Overall,EE was achieved in 65%of all cases.Operative mortality was 2.3%,and no patient died in the EE group.The total number of neonates was 136 accounting for 34.9%of all patients,and the EE rate in neonates was 58.8%.The MVT and ICU length of stay in the EE group were shorter than that in the nonEE group(P<0.001).The re-intubation rate(3.15%vs.12.4%)and postoperative infection rate(1.18%vs.14.6%)in the EE group were lower compared with that in the nonEE group(P<0.05).Conclusion Most neonates and infants with complex CHD can achieve EE after surgery.EE was associated with a lower postoperative infection rate and shorter length of stay of ICU and MVT.Low body weight and BT procedure are independent risk factors for EE in neonates and young infants following complex CHD repair.

关 键 词：心脏病/先天性 心脏病/外科学 气管插管拔除/方法 婴儿 新生 婴儿 

分 类 号：R726.5[医药卫生—儿科]