小儿心内直视手术后多脏器功能障碍综合征的危险因素

Analysis of the risk factors for multiple organ dysfunction syndrome in children after cardiopulmonary bypass

目的分析小儿心内直视手术后多脏器功能障碍综合征（multiple organ dysfunction yndrome, MODS ）的危险因素。方法将2001年1月至2010年12月间完成的1899例先天性心脏病（先心病）手术患儿，按术后有无MODS分为两组，进行单因素分析和多因素Logistic回归分析。结果术后发生MODS35例，发生率为1．84％，病死率为51．43％。单因素分析显示：复杂先心病、围术期发生意外、体外循环时间、主动脉阻断时间、呼吸机辅助时间、术后感染与术后发生MODS有关。经多因素Logistic回归分析显示：复杂先心病、围术期发生意外、体外循环时间超过180min、术后感染为小儿心内直视手术后MODS的危险因素。结论对于存在MODS危险因素的患儿应给予更为细致的围手术期及术后的监测与预防。

Objective To analyze the risk factors associated with multiple organ dysfunction syndrome（MODS） in children after cardiopulmonary bypass （CPB）. Methods Between Jan 2001 and Dec 2010,1 899 patients undergoing open heart surgery were reviewed retrospectively according to the presence or absence of MODS. Univariate and multivariate logistic regression analysis were used to identify the risk factors. Results Thirty-five patients （ 1.84% ） developed MODS, the mortality for MODS was 51.43% （18/35）. Univariate risk factors included complex congenital heart disease, perioperative unexpected events, CPB time, aortic cross-clamping time, mechanical ventilation time, and postoperative spsis. Multivariate logis- tic regression analysis identified that complex congenital heart disease, perioperative unexpected events, CPB time 〉 180 min,postoperative spsis were risk factors. Conclusion The results suggest that the patients with MODS risk factors described above need more careful peri and post operative surveillance and preventive management.