先天性心脏病术后出院再入PICU的病因分析

Etiological analysis of readmission in PICU after congenital cardiac surgery

目的探讨先天性心脏病（先心病）手术后出院再入儿科重症监护病房（PICU）的病因。方法1999年6月～2006年6月我院收治的先心病术后再入PICU患儿56例，回顾性分析其病因、残余血流动力学异常发病率和死因等。结果先心病术后出院再入PICU的病因包括呼吸衰竭、心功能不全、严重心律失常、心包切开综合征和其他系统感染等，患病率4．1‰；24例残余血流动力学异常，发生率43％；死亡14例，病死率25％。结论先心病术后残余血流动力学异常是导致再入PICU和死亡的主要原因。术中彻底纠正解剖畸形、减少并发症和完善随访机制是预防再入PICU的决定性因素。

Objective To analyze the causes of readmission in PICU after congenital cardiac surgery discharge. Methods There were 56 patients readmitted in PICU after congenital cardiac surgery in our hospital from June 1999 to June 2006. The causes of PICU readmission, the incidence of residual hemodynamic abnormalities and death causes were analyzed retrospectively. Results The readmission in PICU after cardiac surgery were due to respiratory failure, cardiac dysfunction, arrhythmia, postpericardiotomy syndrome, other systems infections and so on, showing an incidence of 4.1%o. Twenty-four cases had residual hemodynamic abnormalities and the incidence was as high as 43 %. Fourteen cases died （mortality 25 % ）. Conclusion Postoperation residual hemodynamic problems were the main cause of readmission in PICU and postoperative death. Correcting the anatomic abnorma/ities completely, decreasing the incidences of surgery complications and improving the follow-up policies are the determinative principles to lower readmission rate in PICU.