≤1岁先天性心脏病患儿体外循环术后脑氧去饱和事件危险因素分析  

Risk factors of cerebral oxygen desaturation events after cardiopulmonary bypass in children with congenital heart disease under 1 year old

作　　者：汪思园 陈瑜[1] 孙梦莲 何晓敏 黄坚鹄 沈南平[3] WANG Siyuan;CHEN Yu;SUN Menglian;HE Xiaomin;HUANG Jianhu;SHEN Nanping(Department of Anesthesiology,2.Department of Cardiovascular Surgery,3.Department of Nursing,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心麻醉科,上海200127 [2]上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127 [3]上海交通大学医学院附属上海儿童医学中心护理部,上海200127

出　　处：《临床儿科杂志》2024年第10期843-848,共6页Journal of Clinical Pediatrics

基　　金：上海市医学创新研究专项(No.23Y11907000);上海交通大学医学院附属上海儿童医学中心院级基金项目(No.HL-SCMC2023-2)。

摘　　要：目的 探索≤1岁先天性心脏病(CHD)患儿术后脑氧去饱和事件(CDEs)发生现状及相关危险因素。方法 回顾性分析2023年1至6月体外循环下行CHD矫治术的≤1岁患儿的临床资料,根据术后是否发生CDEs分为发生CDEs组和未发生CDEs组,比较两组间临床特征,分析与CDEs发生相关的影响因素。结果 纳入397例行CHD矫治术的患儿,术后发生CDEs者67例(16.9%),男39例、女28例,中位年龄4.0(3.1~5.6)个月;未发生CDEs者330例(83.1%),男177例、女153例,中位年龄4.5(3.2~7.7)个月。二分类logistic回归分析结果显示,术后较高的外周血氧饱和度(SpO2)和术中较高的红细胞比容(Hct)是CDEs发生的独立保护因素;较长的体外循环时间以及中、深度低温体外循环方案为CDEs发生的独立危险因素(P<0.05)。ROC曲线分析显示,术后SpO2、术中Hct、体外循环时间对CDEs的发生均具有一定的预测价值(AUC>0.6,P<0.05)。结论 ≤1岁CHD患儿术后CDEs发生率较高,通过术后SpO2、术中Hct、体外循环时间与体外循环方案可能预测该年龄段CHD患儿术后CDEs的发生。Objective To investigate the incidence of cerebral oxygen desaturation events(CDEs)and its related risk factors in infants under 1 year old with congenital heart disease(CHD)after surgery.Methods The clinical data of infants under 1 year old with CHD who underwent cardiopulmonary bypass surgery between January and June 2023 were retrospectively analyzed.According to whether CDEs occurred after surgery,the patients were divided into CDEs group and non-CDEs group.The clinical characteristics of the two groups were compared,and the influencing factors related to CDEs occurrence were analyzed.Results Among 397 infants who underwent CHD surgery,67 infants(16.9%)developed CDEs after surgery,including 39 boys and 28 girls,with a median age of 4.0(3.1-5.6)months.There were 330 patients(83.1%)without CDEs,177 boys and 153 girls,with a median age of 4.5(3.2-7.7)months.Binary logistic regression analysis showed that higher postoperative pulse oxygen saturation(SpO2)and higher intraoperative hematocrit(Hct)were independent protective factors for CDEs,while prolonged cardiopulmonary bypass time and moderate to deep hypothermic circulatory arrest were independent risk factors for CDEs(P<0.05).ROC curve analysis showed that postoperative SpO2,intraoperative Hct,and cardiopulmonary bypass time all had certain predictive value for the occurrence of CDEs(AUC>0.6,P<0.05).Conclusions The incidence of postoperative CDEs in CHD infants under 1 year old is higher.Postoperative SpO2,intraoperative Hct,duration of cardiopulmonary bypass and cardiopulmonary bypass regimen may predict the incidence of postoperative CDEs in CHD patients in this age group.

关 键 词：先天性心脏病 体外循环 脑保护 

分 类 号：R726.5[医药卫生—儿科]