先天性心脏病矫治术并发膈肌麻痹的危险因素分析

Risk factors for diaphragmatic paralysis after congenital heart defects surgery

目的:分析先天性心脏病矫治术并发膈肌麻痹的危险因素。方法:2007年1月至2011年7月期间,施行先天性心脏病手术7017例,诊断膈肌麻痹51例,发生率为0.73%,进行单变量及多变量危险因素分析。结果:单变量分析显示,先天性心脏病矫治术合并膈肌麻痹患者的手术年龄(5.9±20.3)个月小于无合并膈肌麻痹患者的手术年龄(47.3±66.3)个月(P<0.001);大血管调转术膈肌麻痹发生率4.8%,高于其他术式的发生率(P<0.001);主动脉弓缩窄/室间隔缺损矫治术膈肌麻痹发生率2.6%,高于其他术式的发生率(P=0.006);完全肺静脉异位引流矫治术膈肌麻痹发生率1.6%,高于其他术式的发生率(P=0.047)。多变量Logistic回归分析显示:较低的手术年龄(P=0.01)、大血管调转术(P<0.001)、主动脉弓缩窄/室间隔缺损矫治术(P=0.005)、完全肺静脉异位引流矫治术(P=0.023)为膈肌麻痹的危险因素。结论:较低的手术年龄、大血管调转术、主动脉弓缩窄/室间隔缺损矫治术、完全肺静脉异位引流矫治术为膈肌麻痹的危险因素。

Objective To analyze the risk factors for diaphragmatic paralysis after congenital heart defects surgery. Methods From January 2007 to July 2011, 5l patients were diagnosed as diaphragmatic paralysis along 7 017 patients with congenital heart defects surgery. The morbidity of diaphragmatic paralysis was 0.73%. Univariate analysis and multivariate analysis were performed to analyze the risk factors for diaphragmatic paralysis. Results Univariate analysis showed that： age [ （5.9±20.3） months] of patients with diaphragmatic paralysis was lower than that [ （47.3±66.3 ） months ] of patient without diaphragmatic paralysis （P 〈 0.001 ）. The morbidity of diaphragmatic paralysis after switch operation was 4.8% （P 〈 0.001）, after coarctation of the aorta and ventricular septal defect （CoA/VSD） operation was 2.6% （P = 0.006）, after total anomalous pulmonary venous connection （TAPVC） operation was 1.6%（P = 0.047）, all were higher than those after any other operation. Multivariate analysis showed that： the risk factors for diaphragmatic paralysis were lower age （P = 0.01）, switch operation （P 〈 0.001）, CoA/ VSD operation （P = 0.005）, TAPVC operation （P = 0.023）. Conclusion The risk factors for diaphragmatic paralysis after congenital heart defects were lower age, switch operation, CoA/VSD operation, and TAPVC operation.