法洛四联症术后毛细血管渗漏综合征的危险因素及治疗

Risk factors for capillary leak syndrome in children with tetralogy after operation

目的:探讨法洛四联症术后发生毛细血管渗漏综合征(capillary leak syndrome,CLS)的相关危险因素及治疗转归。方法:回顾性分析2002年10月至2006年12月本院32例法洛四联症根治术后发生CLS患儿的临床资料,对照组为随机抽取同期50例法洛四联症根治术后未发生CLS的患儿,对可能引起CLS发生的因素采用二分类进行单因素和多因素非条件Logistic逐步回归分析,确定与CLS发病相关的独立危险因素,并对两组患儿术后恢复经过进行总结。结果:1Logistic回归分析显示,法洛四联症根治术后发生CLS的独立危险因素按OR值大小排序分别是:年龄≤3岁(OR=6.783)、体外循环时间≥120 min(OR=4.756)、MGoon指数≤1.6(OR=3.826);2CLS组术后3天内胶体用量和血管活性药物应用时间及呼吸机支持时间,与对照组比较均有统计学差异(P<0.01);CLS组行腹膜透析8例,死亡3例。结论:法洛四联症患儿的年龄、体外循环时间、MGoon指数是术后发生CLS的独立危险因素。发生CLS后早期需用大量胶体维持有效循环血容量,渗漏好转后应加强利尿,同时应积极进行心肺功能支持治疗。

Objective： To determine risk factors of capillary leak syndrome （CLS） in children with tetralogy after operation. Methods： Clinical data were retrospectively collected and analyzed from 32 tetralogy cases with CLS and 50 cases without CLS （control group）, who received operation under cardiopulmonary bypass （CBP） in our hospital from October 2002 to December 2006. Risk factors with statistical significance were screened with univariate logistic regression analysis, independent risk factors of CLS were determined with multivariate logistic regression analysis. Postoperative outcome was compared between CLS group and control group. Results： Logistic analysis showed that the risk factors for CLS were age （OR=6. 783）, duration of CBP （OR=4. 756）and MGoon index （OR=3. 826）. There were statistical differences in injection of colloid,time of inotropic drugs and ventilation between CLS and control groups（P〈0.01）. Eight CLS cases underwent peritoneal dialysis and 2 CLS cases died. Conclusion： The risk factors of CLS in children with tetralogy after CBP are age, duration of CBP and MGoon index.