主动脉弓中断合并室间隔缺损患儿一期根治术后死亡的危险因素分析  

Risk factors for death after one-stage radical surgery in children with interruption of aortic arch and ventricular septal defect

作　　者：宋海龙 张会军[1] SONG Hailong;ZHANG Huijun(Department of Cardiac Surgery,First Hospital of Hebei Medical University,Shijiazhuang,050000,P.R.China)

机构地区：[1]河北医科大学第一医院心脏外科,石家庄050000

出　　处：《中国胸心血管外科临床杂志》2024年第9期1300-1304,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：2022年度河北省医学科学研究课题计划(20220716)。

摘　　要：目的分析主动脉弓中断合并室间隔缺损患儿行一期根治术后死亡的危险因素。方法回顾性分析2006年1月—2017年1月于河北医科大学第一医院行一期根治术的主动脉弓中断合并室间隔缺损患儿的临床资料。采用Cox比例风险回归模型分析一期根治术后死亡的危险因素。结果共纳入152例患者,其中男70例,女82例。术后22例患儿死亡,平均年龄(30.73±9.21)d,存活患儿平均年龄(37.62±11.06)d。低龄[OR=0.551,95%CI(0.320,0.984),P=0.004]、低体重[OR=0.632,95%CI(0.313,0.966),P=0.003]、室间隔缺损直径/主动脉根部内径比值大[OR=2.547,95%CI(1.095,7.517),P=0.044]、体外循环时间长[OR=1.374,95%CI(1.000,3.227),P=0.038]、合并左室流出道梗阻[OR=3.959,95%CI(1.123,9.268),P=0.015]为术后死亡的独立危险因素。结论对于主动脉弓中断合并室间隔缺损患儿,低龄、低体重、室间隔缺损直径/主动脉根部内径比值大、体外循环时间长、合并左室流出道梗阻为一期根治术后死亡的独立危险因素。Objective To analyze the risk factors for death in children with interruption of aortic arch(IAA)and ventricular septal defect(VSD)after one-stage radical surgery.Methods A retrospective analysis was performed on patients with IAA and VSD who underwent one-stage radical treatment in the First Hospital of Hebei Medical University from January 2006 to January 2017.Cox proportional hazards regression model was used to analyze the risk factors for death after the surgery.Results A total of 152 children were enrolled,including 70 males and 82 females.Twenty-two patients died with a mean age of 30.73±9.21 d,and the other 130 patients survived with a mean age of 37.62±11.06 d.The Cox analysis showed that younger age(OR=0.551,95%CI 0.320-0.984,P=0.004),low body weight(OR=0.632,95%CI 0.313-0.966,P=0.003),large ratio of VSD diameter/aortic root diameter(VSD/AO,OR=2.547,95%CI 1.095-7.517,P=0.044),long cardiopulmonary bypass time(OR=1.374,95%CI 1.000-3.227,P=0.038),left ventricular outflow tract obstruction(LVOTO,OR=3.959,95%CI 1.123-9.268,P=0.015)were independent risk factors for postoperative death.Conclusion For children with IAA and VSD,younger age,low body weight,large ratio of VSD/AO,long cardiopulmonary bypass time and LVOTO are risk factors for death after one-stage radical surgery.

关 键 词：主动脉弓中断 室间隔缺损 左室流出道梗阻 体外循环 体外膜肺氧合 连续性肾脏替代治疗 危险因素 

分 类 号：R726.5[医药卫生—儿科]