低出生体重食管闭锁患儿预后因素的研究

Prognostic factors of survival rate after repair of esophageal atresia （EA） and/or tracheoesophageal fistula （TEF）

目的 本文回顾性分析影响低出生体重（＜2.5kg）食管闭锁患儿预后的因素,旨在指导临床判断.方法 对1999年1月至2008年12月收治入本院的食管闭锁患儿回顾性分析：①生存率与出生体重相关性;②低出生体重儿术前急性事件（难以控制高热、呼吸衰竭、血流动力学等）和术中急性事件（插管困难、通气困难、血氧饱和度＜90%等）发生率;③出生体重与术后并发症、术后机械通气时间及生存率的关系;④术后应激性高血糖与生存率及术后并发症的相关性;⑤Logistic回归模型分析低出生体重、心脏畸形、术后高血糖对生存率的影响.结果 101例食管闭锁患儿中,出生体重＜2 500 g的患儿29例.总生存率87.2%,低出生体重儿生存率较低（75.9%vs 92.3%,P=0.027）,体重越轻,生存率越低,二者正相关（r=0.946,P=0.015）.术前急性事件和术中急性事件发生率明显高于正常出生体重儿（67.7%vs 32.9%,P=0.002;70%vs 26%,P=0.001）.吻合口瘘和狭窄发生率高,术后机械通气时间延长（P=0.001）.术后应激性高血糖者总体生存率低（93.6%vs81.0%,P=0.024）,高血糖与生存率呈负相关（r=-0.931,P=0.022）,Logistic回归分析资料表明应激性高血糖对食管闭锁预后有独立的影响作用.结论 低出生体重是影响食管闭锁生存率的主要因素,体重越轻,生存率越低;术中、术后并发症较高;术后应激性高血糖是影响生存率的重要因素之一.

Objective To investigate the prognostic factors of survival rate after repair of esophageal atresia （EA） and/or tracheoesophageal fistula （TEF）. Methods The clinical data of the 101 patients underwent TEF/EA repair between January 1999 and December 2008 at this center were retrospectively reviewed. The patients were divided into low-birth-weight group （29 patients, birth-weight〈2 500 grams） and normal-birth-weight group （72 patients, birth-weight〉2. 5 kg）. The possible prognostic factors were retrospectively analyzed including patients status, the incidence of preoperative and intraoperative critical events, postoperative complications, postoperative mechanical ventilation time,stress hyperglycemia and survival rate. Logistic regression analysis was employed to predict the prognostic factors of the survival rate after repair of EA and/or TEF. Results Of the 29 low-birth-weight EA patients, the survival rate was significantly lower than that of the normal birth weight patients （75.9% vs 92. 3% ,P = 0. 027） ,and the survival rate positively correlated with the birth weight （r = 0. 946,P = 0. 015）. The incidence of preoperative and intraoperative critical events and postoperative complications in low-birth-weight EA patients were significantly higher than those of the normal birth weight patients （67. 7% vs 32. 9%,P = 0. 002; 70% vs 26%,P = 0. 001）. The morbidity of anastomotic stricture and leak was higher, and postoperative mechanical ventilation time was longer compared with the normal birth weight patients （P = 0. 001 ）. The survival rate of the patients had postoperative stress hyperglycemia was lower than that of patients without stress hyperglycemia （93.6% vs 81. 0%, P = 0. 024） ,and the survival rate negatively correlated with the severity of postoperative stress hyper glycemia （r= - 0. 931,P = 0. 022）. Conclusions cemia are the prognostic factors of survival rate Low-birth-weight and postoperative stress hypergly after repair of EA and/or TEF.