先天性心脏病体肺分流术后早期失败危险因素分析

Risk factors for early failure after systemic-to-pulmonary artery shunt in congenital heart disease

目的分析青紫型先天性心脏病(CHD)行体肺分流术后早期失败的危险因素。方法对接受体肺分流术的73例青紫型CHD患儿的病史资料进行回顾性分析。搜集患儿围术期的客观指标,分别采用χ2检验和Logistic回归对体肺分流术后早期失败事件进行单因素和多因素分析。结果术后14例患儿发生早期失败。χ2检验结果显示:肺动脉闭锁/室间隔完整、年龄≤60 d、体外循环下手术、术中同期行肺动脉扩大术和术后正性肌力药物评分最大值(ISmax)>20是影响患儿早期失败的相关危险因素;Logistic回归分析显示:术中同期行肺动脉扩大术及术后ISmax>20是早期失败的独立危险因素。结论对于存在体肺分流术后早期失败危险因素的青紫型CHD患儿,体肺分流术后早期应加强监护,以减少术后早期失败的发生。

Objective To analyse the risk factors for the early failure of systemic-to-pulmonary artery shunt in cyanotic congenital heart disease(CHD).Methods The clinical data of 73 patients with cyanotic CHD undergoing systemic-to-pulmonary artery shunt were retrospectively analysed.The perioperative objective parameters were collected.Univariant analysis was performed with Chi-square test and multivariate analysis was carried out with Logistic regression analysis to seek the risk factors for early failure after systemic-to-pulmonary artery shunt.Results Fourteen patients experienced early failure.Chi-square test indicated that pulmonary atresia/intact ventricular septum,age no more than 60 d,long time of cardiopulmonary bypass,pulmonary artery enlargement and higher maximal inotrope score(ISmax>20) after surgery were associated with early failure.Logistic regression analysis revealed that pulmonary artery enlargement and ISmax>20 after surgery were independent risk factors for early failure.Conclusion For patients with cyanotic CHD having risk factors for early failure after systemic-to-pulmonary artery shunt,the management of intensive care after systemic-to-pulmonary artery shunt should be enhanced to reduce the incidence of early failure.