婴儿先天性心脏病术中延迟关胸的危险因素分析  

Analysis of risk factors of congenital heart disease intraoperative delayed sternal closure in infants

作　　者：比拉力·排祖拉 迪娜·努尔兰 何丽芸[2] 杨龙[1] 王月茹 伊木然·卡吾力江 陈基尧 张国明[1] Bilali Paizula;Dina Nuerlan;He Li-yun;Yang Long;Wang Yue-ru;Yimuran Kawulijiang;Chen Ji-yao;Zhang Guo-ming(Department of Pediatric Cardiothoracic Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830054,China;Central Operating Room,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830054,China)

机构地区：[1]新疆医科大学第一附属医院小儿心胸外科,新疆乌鲁木齐830054 [2]新疆医科大学第一附属医院中心手术室,新疆乌鲁木齐830054

出　　处：《中国现代医学杂志》2025年第7期1-7,共7页China Journal of Modern Medicine

基　　金：新疆维吾尔自治区天山英才培养计划(No:TSYC202301B036);新疆维吾尔自治区研究生创新项目(No:XJ2024G167)。

摘　　要：目的探讨婴儿先天性心脏病术中行延迟关胸的危险因素。方法回顾性分析2016年1月1日—2021年12月30日在新疆医科大学第一附属医院小儿心胸外科行体外循环下正中胸骨切开术的210例先天性心脏病患儿的临床资料。术中24例接受延迟关胸患儿为延迟关胸组,186例直接关胸患儿为直接关胸组。比较两组患儿的临床资料,采用单因素及多因素一般Logistic回归模型分析术中延迟关胸的影响因素。结果婴儿先天性心脏病术中延迟关胸的发生率为11.4%。延迟关胸组与直接关胸组患儿的性别构成、早产率、体质量指数、左室射血分数比较,差异均无统计学意义(P>0.05);延迟关胸组与直接关胸组患儿的年龄构成、改良Ross心功能分级构成、二尖瓣舒张早期血流速度峰值(E峰)/二尖瓣环室间隔处舒张早期血流速度峰值(e’峰)构成、肺动脉高压构成、先天性心脏病手术风险分级(RACHS-1)构成、体外循环时间构成、主动脉阻断时间构成、心胸比率和手术时间比较,差异均有统计学意义(P<0.05)。单因素一般Logistic回归分析显示:年龄≤6个月、改良Ross心功能分级≥3级、E/e’值>10、中重度肺动脉高压、RACHS-1分级>3级、手术时间的增加、体外循环时间≥120 min和主动脉阻断时间≥60 min有统计学意义(P<0.05)。多因素一般Logistic回归分析显示:年龄≤6个月[OR=5.488(95%CI:1.795,16.779)],RACHS-1分级>3级[OR=6.895(95%CI:2.171,21.903)]、体外循环时间≥120 min[OR=2.945(95%CI:1.058,8.192)]均是术中延迟关胸的危险因素(P<0.05)。结论年龄≤6个月、RACHS-1分级>3级、体外循环时间≥120 min均是术中延迟关胸的危险因素。Objective To investigate the risk factors for intraoperative delayed sternal closure(DSC)in infants with congenital heart disease(CHD).Method A retrospective analysis was conducted on 210 children with CHD(aged≤12 months)who underwent median sternotomy and cardiopulmonary bypass(CPB)cardiac surgery in the Department of Pediatric Cardiothoracic Surgery of the First Affiliated Hospital of Xinjiang Medical University from January 1,2016 to December 30,2021.The patients were divided into two groups:24 cases with delaye sternal closure(DSC)during the operation were assigned to the DSC group,and 186 cases with direct sternal closure during the operation were assigned to the direct sternal closure group.Univariate and multivariate Logistic general regression analyses were performed to identify the influencing factors of DSC in the children during the operation.Results The incidence of intraoperative DSC in infants with CHD was 11.4%.There were no significant differences in gender composition,premature birth rate,body mass index(BMI)and left ventricular ejection fractions(LVEF)between the DSC group and the direct sternal closure group(P>0.05).There were statistically significant differences in age composition,modified ROSS score composition,E/e'value composition,pulmonary hypertension composition,risk adjustment for congenital heart surgery(RACHS-1)score composition,cardiothoracic ratio(CTR),operation time,CPB time and aortic cross-clamp(ACC)time between DSC group and direct sternal closure group(P<0.05).Univariate general Logistic regression analysis showed that age≤6 months,modified ROSS score≥3,E/e'value>10,moderate to severe pulmonary hypertension,RACHS-1 score>3,increased operation time,CPB time≥120 min and ACC time≥60 min were statistically significant(P<0.05).Multivariate general Logistic regression analysis showed that age≤6 months[OR=5.488(95%CI:1.795,16.779)],RACHS-1 score>3[OR=6.895(95%CI:2.171,21.903)],and CPB time≥120 min[OR=2.945(95%CI:1.058,8.192)]were all risk factors for intraoperative DSC.

关 键 词：先天性心脏病 心脏外科手术 延迟关胸 危险因素 婴儿 

分 类 号：R541.1[医药卫生—心血管疾病]