小儿先天性心脏病术后高胆红素血症的危险因素分析  

Analysis on the Risk Factors of Postoperative Hyperbilirubinemia in Children with Congenital Heart Disease

作　　者：孟才华 佘应军 曾燕 张娜 刘文兴 MENG Caihua;SHE Yingjun;ZENG Yan;ZHANG Na;LIU Wenxing(The Women and Children's Medical Center Affiliated to Guangzhou Medical University,Guangzhou 510623,China)

机构地区：[1]广州医科大学附属妇女儿童医疗中心,广东广州510623

出　　处：《临床医学工程》2024年第12期1478-1480,共3页Clinical Medicine & Engineering

基　　金：广东省基础与应用基础研究基金项目(2021A1515220058)。

摘　　要：目的分析小儿先天性心脏病术后高胆红素血症的危险因素及对预后的影响。方法回顾性分析2015年7月至2023年2月于我中心心脏外科行先天性心脏病手术的5828例患儿的病历资料,根据术后7 d血清总胆红素(TBIL)水平的最大值,将患儿分为高胆红素血症组(TBIL>51μmol/L,882例)和对照组(TBIL≤51μmol/L,4946例)。比较两组的围术期相关指标,采用单因素和多因素Logistic回归模型分析小儿先天性心脏病术后高胆红素血症的独立危险因素。结果小儿先天性心脏病术后高胆红素血症发生率为15.1%。多因素Logistic回归分析显示,术前TBIL>17μmol/L(OR=12.986,P=0.005)、直接胆红素(DBIL)>7μmol/L(OR=8.107,P=0.015)是小儿先天性心脏病术后高胆红素血症的独立危险因素;两组的术后病死率、术后急性肾损伤发生率、机械通气时间、ICU停留时间、住院时间及住院费用比较,差异均有统计学意义(P<0.005)。结论术前TBIL>17μmol/L、DBIL>7μmol/L是小儿先天性心脏病术后发生高胆红素血症独立危险因素。术后高胆红素血症与术后病死率、术后急性肾损伤发生率增高,ICU停留时间、机械通气时间、住院时间延长,住院费用增加显著相关。Objective To analyze the risk factors and impact on prognosis of hyperbilirubinemia after congenital heart disease surgery in children.Methods The medical record data of 5828 children with congenital heart disease surgery in the Department of Cardiac Surgery of our center from July 2015 to February 2023 were retrospectively analyzed.According to the maximum value of serum total bilirubin(TBIL)level at 7 d after surgery,all cases were divided into hyperbilirubinemia group(TBIL>51μmol/L,882 cases)and control group(TBIL≤51μmol/L,4946 cases).The perioperative related indicators were compared between the two groups,and univariate and multivariate Logistic regression models were used to analyze the independent risk factors for postoperative hyperbilirubinemia in children with congenital heart disease.Results The incidence of postoperative hyperbilirubinemia in children with congenital heart disease was 15.1%.Multivariate Logistic regression analysis showed that preoperative TBIL>17μmol/L(OR=12.986,P=0.005)and DBIL>7μmol/L(OR=8.107,P=0.015)were independent risk factors for postoperative hyperbilirubinemia in children with congenital heart disease.The comparison of postoperative mortality rate,incidence of postoperative acute kidney injury,mechanical ventilation time,ICU stay time,hospitalization time,and hospitalization cost between the two groups showed statistically significant differences(P<0.05).Conclusions Preoperative TBIL>17μmol/L and DBIL>7μmol/L are independent risk factors for postoperative hyperbilirubinemia in children with congenital heart disease.Postoperative hyperbilirubinemia is significantly associated with increased postoperative mortality and incidence of postoperative acute kidney injury,prolonged ICU stay time,mechanical ventilation time and hospitalization time,and increased hospitalization cost.

关 键 词：术后高胆红素血症 心脏手术 危险因素 小儿 

分 类 号：R619[医药卫生—外科学]