小儿法洛四联症根治术后ICU滞留危险因素分析

Risk factors for prolonged stay in intensive care unit in children with tetralogy of Fallot undergoing corrective surgery

目的分析造成小儿法洛四联症（Tetralogy of Fallot，TOF）根治术后ICU滞留的主要影响因素，探讨改进疗效的方法。方法将2007年1月～2008年6月连续实施的329例TOF根治患儿，根据术后ICU时间分组，Ⅰ组为ICU时间〈7d，Ⅱ组为ICU时间≥7d。以年龄、性别、体质量、Nakata指数、体外循环时间、跨环补片数等作为观察变量，先对变量进行单凶素分析，然后将有意义的变量纳入Logistic回归分析。结果术后ICU滞留45例，ICU滞留的直接原因中，最多见的是肺渗出，其次是低心排。Ⅰ组死亡3例，手术死亡率1％；Ⅱ组死亡5例，手术死亡率11％（两组差异显著，P〈0．01），单因素分析显示，ICU滞留组与未滞留组比较，其年龄低，Nakata指数小，体外循环时间长，跨环补片例数多，术后呼吸机辅助时间延长，其差异均有统计学意义。Logistic回归显示：年龄≤6个月．Nakata指数〈140mm^2／m^2，体外循环时间〉150min是TOF根治术ICU滞留的危险因素。结论年龄偏小，Nakata指数偏低和体外循环时间长是术后ICU滞留的危险因素。

AIM ： To analyze the risk factors for prolonged stay in intensive care unit （ICU） after corrective surgery for tetralogy of Fallot （TOF）. METHODS： Between January 2007 and June 2008, 329 consecutive patients with TOF undergoing corrective surgery were divided into two groups based on the length of stay in ICU. Prolonged stay in ICU was defined as 7 days or more. Group I was comprised of 284 patients with no prolonged ICU stay. Group II was comprised of 45 patients with prolonged ICU stay. Uni- and multivariate analysis were used to identify risk factors. RESULTS： Univariate analysis showed that group II subjects were younger and the Nakata index was lower compared with those in group Ⅰ. Ventilation time, bypass time, clamping time, presence of transannular patch and rate of infection were longer or higher in group Ⅱ than in group Ⅰ. Logistic regression showed that risk factors for prolonged ICU stay were age ≤6 months, Nakata index 〈 140 mm^2/m^2 and cardiopulmonary bypass time 〉 150 min. CONCLUSION： Prolonged ICU stay after corrective operation of TOF can be predicted by risk factors. Patients with these risk factors require more pre- and postoperative care to reduce mortality and morbidity and to avoid prolonged postoperative ICU time.