儿童先天性心脏病术后延迟关胸的危险因素分析  

Analysis of risk factors for delay sternal closure after surgery for congenital cardiac disease in children

作　　者：宋奕霄 陈曦 张明杰[1] 王丽平 庞亚昌 徐卓明[1] Song Yixiao;Chen Xi;Zhang Mingjie;Wang Liping;Pang Yachang;Xu Zhuoming(Cardiothoracic Surgery Intensive Care Unit,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心胸外科重症监护室,200127

出　　处：《中国小儿急救医学》2024年第11期851-855,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的为预防先天性心脏病术后心肌水肿或其他原因引起的急性心力衰竭,预见性地为患儿实施延迟关胸,可能在某种程度上降低患儿术后需要心肺复苏的可能性。本研究旨在描述先天性心脏病术后延迟关胸的比例,并分析可能与之相关的危险因素。方法对上海儿童医学中心心胸外科重症监护室2014年9月至2018年12月近5年间所有涉及体外循环的手术进行回顾性研究。研究队列根据是否采用延迟关胸分为延迟关胸组(n=418)和对照组(常规关胸,n=12188)。采用多因素Logistic回归分析探究与延迟关胸相关的危险因素。结果共12606例符合要求的病例,其中延迟关胸组418例(3.32%)。延迟关胸组中最常见的心脏病诊断为大动脉转位(26.8%,112/418),而对照组中室间隔缺损最为常见(45.9%,5599/12188)。延迟关胸组患儿全因病死率为3.3%(14/418),对照组为0.4%(46/12188),差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,术后需要采用延迟关胸可能与年龄(OR 0.164,95%CI 0.079~0.338,P<0.001)、性别(OR 0.742,95%CI 0.648~1.098,P<0.05)、平均体重(OR 1.192,95%CI 1.078~1.318,P<0.001)、术前正性肌力药物支持(OR 0.370,95%CI 0.252~0.699,P<0.001)、复杂手术(OR 0.241,95%CI 0.159~0.367,P<0.001),以及体外循环转流时间(OR 6.412,95%CI 4.339~9.475,P<0.001)相关。结论延迟关胸是婴儿及儿童先天性心脏病手术中的重要处理方法,手术时年龄、性别、平均体重、术前正性肌力药物支持、复杂手术以及体外循环转流时间可能与需要采用延迟关胸相关。ObjectiveTo prevent postoperative myocardial oedema or other causes of acute heart failure in congenital cardiac disease,anticipating delay sternal closure may reduce the number of children requiring cardiopulmonary resuscitation after surgery.The aim of this study was to describe the rate of delay sternal closure after surgery for congenital cardiac disease and to analyse the risk factors that may be associated with it.MethodsWe retrospectively reviewed all surgeries with extracorporeal circulation in the cardiothoracic surgery intensive care unit of Shanghai Children's Medical Center in the past five years,from September 2014 to December 2018.The study cohort was divided into the delay sternal closure group(n=418)and the control group(routine chest closure,n=12188)according to whether a delay sternal closure was applicated.Risk factors associated with delay sternal closure were identified by multivariate Logistic regression analysis.ResultsA total of 12606 cases were eligible,of which 418(3.32%)were in the delayed sternal closure group.The most common cardiac diagnosis in the delayed sternal group was transposition of the great arteries(26.8%,112/418),whereas the most common cardiac diagnosis in the control group was ventricular septal defect(45.9%,5599/12188).All-cause mortality in children in the delayed sternal closure group was 3.3%(14/418)compared with 0.4%(46/12188)in the control group,with a statistically significant difference(P<0.05).Multivariate Logistic regression analysis showed that the need for delayed sternal closure were associated with age(OR 0.164,95%CI 0.079-0.338,P<0.001),positive intropic support before surgery(OR 0.42,95%CI 0.252-0.699,P=0.001),sex(OR 0.742,95%CI 0.648-1.098,P<0.05),mean body weight(OR 1.192,95%CI 1.078-1.318,P<0.001),positive intropic support before surgery(OR 0.370,95%CI 0.252-0.699,P<0.001),complicated surgery(OR 0.241,95%CI 0.159-0.367,P<0.001)and extracorporeal circulation diversion time(OR 6.412,95%CI 4.339-9.475,P<0.001).ConclusionDelayed sternal closure is an impor

关 键 词：先天性心脏病 延迟关胸 危险因素 急性心力衰竭 儿童 

分 类 号：R726.5[医药卫生—儿科]