复杂型先天性心脏病术后并发低心排量综合征的危险因素

Analysis of risk factors causing low cardiac output syndrome in patients with complicated congenital heart disease

目的：探讨复杂型先天性心脏病（CHD）术后低心排血量综合征（lowcardiac output syndrome,LCOS）发生的相关因素。方法：随机选择64例接受根治手术的复杂型CHD患儿。术后通过脉波指示连续心排血量（pulse-indicated continuous cardiac output,PiCCO）法监测患儿术后24h的心脏指数（cardiac index,CI）,体循环血管阻力指数（systemic vascular resistance index,SVRI）,肺循环血管阻力指数（pul monary vascular resistance index,PVRI）等血流动力学指标。利用危险度分析来确定复杂型CHD术后LCOS发生的危险因素。结果：30例（46.9%）发生LCOS。发生LCOS的患儿年龄平均为（9.8±11.3）月,无LCOS的患儿年龄平均（18.3±21.5）月（P〈0.05）;平均体重分别为（6.7±2.6）kg和（8.6±4.1）kg（P=0.045）;患儿年龄≤6个月,其LCOS的发病率高达76.5%,年龄1-2岁的,LCOS发病率仅为33.3%（P〈0.05）,年龄与LCOS发病率呈负相关（RR=3.9,P〈0.01）;体重〉10kg时,LCOS的发病率为30.8%,而体重≤6kg,LCOS的发病率则高达65.2%（P〈0.05）,体重与LCOS发病率呈负相关（RR=2.1,P〈0.05）。术前存在肺动脉高压,主动脉阻断时间、体外循环时间长,术后体、肺循环阻力高等是复杂型CHD患儿术后LCOS发生的危险因素（P〈0.05）,其中体循环阻力增高尤为显著（P=0.000）。结论：低年龄,小体重,术前存在肺动脉高压,主动脉阻断时间、体外循环时间长和术后体、肺循环阻力高等是复杂型CHD患儿术后LCOS发生的危险因素。

Objective： To evaluate the risk factors of low cardiac output syndrome （LCOS） during the early post-operative period of complicated congenital heart disease （CHD）. Methods： With the aim, 64 children with complicated CHD following corrective open heart surgery were selected randomly. Cardiac index （CI）, systemic vascular resistance index （SVRI） and pulmonary vascular resistance index （PVRI） were measured persistently by the continuous pulse contour method during the first 24h after the operation. Patients were divided into two groups： with or without LCOS group. Cardiac index of ≤2.4 L/min per m^2 was defined as LCOS. Using correlation analysis method to evaluate the risk factors of LCOS in the early post-operative period of complicated CHD. Results： Thirty patients （46.9%） developed LCOS during the first 24 h after surgery. Negative correlation was found between age, weight and incidence of LCOS （RR=3.9, 2.1, P〈0. 01, 〈0.05 respectively）. When age≤6 m the incidence of LCOS was 76.5%, when ly≤age≤2y the incidence was 33.3% （P〈0.05）. The lower the patient＇s weight, the higher the incidence of LCOS： weight〉10kg, incidence： 30.8 % （P〈0.05）, weight≤6kg, incidence. 65.2%. Conclusion： The risk factors of LCOS were found as follows., younger age, lower weight, associated with pulmonary hypertension before operation, prolonged durations of cardiopulmonary bypass and aortic cross-clamp, elevated systemic vascular resistance and pulmonary vascular resistance after operation.