ALCAPA患者行矫治术后低心排综合征的危险因素及其对临床结局的影响  

Risk Factors and Associated Clinical Outcomes of Postoperative Low Cardiac Output Syndrome among Pediatric Patients with ALCAPA Undergoing Surgical Repair

作　　者：方仲蓉 王春蓉 王越夫 晏馥霞 FANG Zhongrong;WANG Chunrong;WANG Yuefu;YAN Fuxia(Department of Anesthesiology,Fuwai Hoaspital,Chinese Academy of Medical,National Center for Cardiovascular Diseases,Beijing 100037,China;Department of Anesthesiology,Beijing Shjian Haspital,Capital Medical University,Beijing 100038,China)

机构地区：[1]国家心血管病中心中国医学科学院阜外医院麻醉中心,北京市100037 [2]首都医科大学附属北京世纪坛医院麻醉中心外科重症医学科,北京市100037

出　　处：《中国分子心脏病学杂志》2022年第3期4649-4652,共4页Molecular Cardiology of China

摘　　要：目的评价左冠状动脉异常起源于肺动脉(ALCAPA)患儿矫治术后发生低心排综合征(LCOS)的危险因素及其对临床结局的影响。方法ALCAPA患儿共87例,根据患儿术后是否发生LCOS,将其分为LCOS组和非LCOS组。采用分类回归树(CART)方法判断术后出现LCOS的高危人群。结果31例患儿术后发生LCOS,发生率为35.6%。CART显示,术前左心室射血分数(LVEF)≤32.5%且年龄≤6.5月龄的患儿最易发生LCOS,其次为LVEF≤32.5%且年龄>6.5月龄患儿。LCOS风险最低为LVEF>32.5%患儿群体。上述3组患儿发生LCOS分别为16例、8例和7例,发生率分别为100%、53.3%和12.5%。与无LCOS患儿相比,LCOS患儿术后机械通气时间和ICU停留时间显著延长,急性肾损伤发生率和院内死亡率均显著增高。结论术前患儿LVEF降低和年龄偏小是术后发生LCOS的危险因素,其中LVEF≤32.5%和年龄≤6月龄发生风险最大。Objective To identify the risk factors for postoperative low cardiac output syndrome(LCOS)in children with anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)who underwent surgical repair,and to assess the clinical outcomes of LCOS.Methods In total,there were 87 pediatric patients included into our final analysis.They were divided into the LCOS group and the no LCOS group.Classification and regression tree(CART)was employed to determine the patients with highest risk of LCOS development.Results Of all patients,31 developed postoperative LCOS.The incidence was 35.6%.CART demonstrated that,among patients having left ventricular ejection fraction(LVEF)≤32.5%,age≤6.5 months at repair presented greatest risk to develop LCOS and then those aging older than 6.5 months ranked second.Those with LVEF>32.5%ranked third with regard to LCOS.The number of patients developed LCOS in the above three groups was 16,8,and 7,respectively,whereas the incidence was 100%,53.3%and 12.5%,respectively.Compared with those without LCOS,patients developing LCOS gained significantly longer durations of mechanical ventilation and the length of intensive care unit stay,as well as higher frequencies of acute kidney injury and in-hospital mortality.Conclusion The decrease of LVEF and younger age are the risk factors of postoperative LCOS,among which LVEF≤32.5%and age≤6 months are the most dangerous.

关 键 词：患儿 左冠状动脉异常起源于肺动脉 低心排综合征 危险因素 预后 

分 类 号：R614[医药卫生—麻醉学]