法洛氏四联症一期根治术后早期急性肺损伤相关危险因素分析

Analysis of the risk factors for the acute lung injury after correction of tetralogy of Fallot

目的分析法洛氏四联症(TOF)一期根治术后并发早期急性肺损伤(ALI)的危险因素,探讨预防的相关措施。方法分析147例法洛氏四联症Ⅰ期根治术围手术期的相关情况。其中,男63例,女84例。术后ALI包括灌注肺、严重低氧血症、肺不张或液气胸等。利用单因素分析及Logistic逐步回归统计分析ALI发生的相关危险因素。结果紫绀发病年龄<3.2个月,Nakata指数<140mm2/m2,AO/PA比值>2.6,跨瓣环补片,体外循环时间>107min,主动脉阻断时间>81min以及术后呼吸机辅助呼吸时间<11h等因素与术后ALI发生有关。结论Nakata指数<140mm2/m2、体外循环时间>107min、主动脉阻断时间>81min是TOF术后早期肺损伤发生的危险因素。

[Objective] To analyze the risk factors causing early postoperative acute lung injury （ALl） after correction of Tetralogy of Fallot （TOF）. [Method] We analyzed 24 valiables in147 patients underwent the correction of TOF, including 63 males and 84 females. ALl means lung perfusion, ARDS, pneumothorax and so on.Finding the risk fators with univariate and multiple logistic discriminant analysis. [Result] Univariate analysis demonstrated a significant association between early ALl and the following variables： age for cyanosis to be present〈3.2 months （8/ 41VS5/106, P 〈0.05, Nakata index〈140 mm^2/m^2 （10/46VS3/101, P 〈0.05）, AO/PA〉2.6 （11/57VS2/90）, transannular patching （9/49VS4/98,P 〈0.05）, the total cardiopulmonary bypass （CPB） time〉107 min （8/38VS5/109, P 〈0.05）, and aortic clamp time〉81min （8/40VS5/107, P 〈0.05）, mechanical ventilation time〈ll hours （9/51VS4/96, P 〈0.05）. Multiple logistic discriminant analysis demonstrated that Nakata index〈140 mm^2/m^2, the total cardiopulmonary bypass （CPB） time〉107 min, and aortic clamp time〉81mins, are real risk factors. [Conclusion] Pulmonary artery hypoplasia, CPB times and aortic clamp times are connective with ALI.