影响儿童法洛四联症根治术后快通道康复的危险因素分析  

Analysis of risk factors affecting fast track rehabilitation after complete repair of Tetralogy of Fallot in children

作　　者：于欢 刘志刚[2] 王伟[3] 魏茂提 龙曼曼 杜超 董军[2] 路万里[2] 刘晓程[2] YU Huan;LIU Zhi-gang;WANG Wei;WEI Mao-ti;LONG Man-man;DU Chao;DONG Jun;LU Wan-li;LIU Xiao-cheng(Graduate School of Chengde Medical University,067000;Department of cardiac surgery,Teda International Cardiovascular Hospital,300457 Tianjin,China;The Intensive Care Unite,Teda International Cardiovascular Hospital,300457 Tianjin,China;Department of Epidemiology center,Teda International Cardiovascular Hospital,300457 Tianjin,China)

机构地区：[1]承德医学院研究生院,河北省承德市067000 [2]泰达国际心血管病医院心外科 [3]泰达国际心血管病医院ICU [4]泰达国际心血管病医院流行病学中心

出　　处：《中国心血管病研究》2022年第5期417-421,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探索影响儿童法洛四联症(TOF)根治术后快通道康复的相关危险因素。方法回顾性分析泰达国际心血管病医院2019年1月至2021年12月行TOF根治术的患者临床资料,按术后呼吸机使用时间是否长于6 h将患者分为延迟拔管组和快通道拔管组。采用logistic回归分析进行因素校正,对比两组患儿围手术期及术中各项变量,探寻TOF根治术后延迟拔管的危险因素。结果:共纳入135例患儿,其中男性77例(57.0%)、女性58例(43.0%),中位年龄27(13,53)月。研究期间内发生延迟拔管48例,发生率呈逐年降低趋势(P<0.001)。回归分析显示,性别、年龄、体重、身高、C-反应蛋白、肺动脉狭窄、主-肺动脉侧支、跨瓣环补片、体外循环时间、主动脉阻断时间均与延迟拔管的发生相关(P<0.05)。对上述危险因素进行校正后(多因素logistic分析)结果显示,女性(OR=3.095,95%CI 1.406~6.813,P=0.005)、存在主-肺动脉侧支(OR=3.138,95%CI 1.462~6.736,P=0.003)以及体外循环时间延长(OR=1.017,95%CI 1.006~1.027,P=0.002)更易发生延迟拔管,而发育相对越好[身高(OR=0.961,95%CI 0.939~0.984,P=0.001)]是TOF根治术后快通道拔管的保护因素。一旦发生延迟拔管,ICU滞留时间和术后住院时间均显著延长(P<0.001)。结论尽管TOF根治术后延迟拔管的发生率逐渐降低,女性、存在主-肺动脉侧支及体外循环时间延长仍然是TOF术后延迟拔管的危险因素。Objective To explore the risk factors of fast track rehabilitation after complete repair of Tetralogy of Fallot(TOF)in children.Methods The clinical data of patients who underwent TOF total corrective operation in TEDA International Cardiovascular Hospital from January 2019 to December 2021 were analyzed retrospectively.According to whether the ventilation time postoperation was longer than 6 hours or not,the patients were divided into the delayed extubation group and fast track group.The perioperative and intraoperative variables of the two groups were compared and the risk factors affecting delayed extubation were investigated.All the factors were corrected by logistic regression analysis.Results A total of 135 children were included,with 77males(57.0%)and 58 females(43.0%)and with a median age of 27(13,53)months.There were 48 cases of delayed extubation during the study period,showing a decreasing trend year by year(P<0.001).Gender,age,weight,height,C-reactive protein,pulmonary artery stenosis,major aorta-pulmonary collateral arteries,transannular patch repair,cardiopulmonary bypass(CPB)time and aortic cross-clamp time were all related to the occurrence of delayed extubation(P<0.05).After adjusting for factors(multivariate logistic analysis),female(OR=3.095,95%CI 1.406-6.813,P=0.005),the presence of major aorta-pulmonary collateral arteries(OR=3.138,95%CI1.462-6.736,P=0.003)and longer CPB time(OR=1.017,95%CI 1.006-1.027,P=0.002)were more likely to have delayed extubation,yet the relatively better development[height(OR=0.961,95%CI 0.939-0.984,P=0.001)]was the protective factor of delayed extubation after TOF radical operation.Once delayed extubation occurred,the ICU residence time and postoperative hospital stay were significantly prolonged(P<0.001).Conclusion The incidence of delayed extubation in the patients after TOF complete repair decreases over time.Female,the presence of major aortal-pulmonary collateral arteries and the prolonged CPB are the risk factors of delayed extubation.

关 键 词：法洛四联症 延迟拔管 危险因素 快通道麻醉 

分 类 号：R541.1[医药卫生—心血管疾病]