影响完全性肺静脉异位引流术病死率的危险因素

Risk factors for mortality of total anomalous pulmonary venous connection

目的分析完全性肺静脉异位引流（TAPVC）纠治术的手术结果，探讨影响其病死率的危险因素。方法对比分析郑州大学第三附属医院河南省小儿先心病诊疗中心2001年9月至2011年9月收集的TAPVC患儿临床资料。其中男37例，女20例；年龄15d-6．5岁[（4．27±8．63）个月]；体质量4．0～21．0（6．33±2．70）kg。收集患儿住院病历、超声心动图和手术记录等资料。应用x^2检验和Logistic多变量回归分析对患者的手术年龄、体质量、TAPVC分型、术前急症、主动脉钳夹时间、手术时间、体外循环时间及术后呼吸机辅助时间、监护时间、住院时间等因素进行分析，分析影响病死率的危险因素。结果57例TAPVC患儿纠治术中，围手术期死亡7例（12．2％）。单变量分析结果表明，与TAPVC纠治术病死率相关的因素有体质量（P=0．035）、TAPVC分型（P=0．037）、术前急症（P=0．021）、主动脉钳夹时间（P=0．046）。Logistic多变量回归分析结果表明，术前急症是影响TAPVC纠治术病死率的独立危险因素（P=0．003）。结论TAPVC患儿术前急症会增加患儿术后的病死率。

Objective To analyze the outcomes of the surgery repair for total anomalous pulmonary venous connection （ TAPVC）, and to investigate the risk factors which influence the mortality of the operation. Methods Com- parative analysis was performed in the children with TAPVC who were treated operatively from Sep. 2001 to Sep. 2011 in the Third Affiliated Hospital of Zhengzhou University, Henan Diagnosis ＆ Treatment Center of Congenital Heart Di- sease. The children included 37 male and 20 female,aged from 15 days to 6.5 years[ （4.27± 8.63 ） months] ,with body weight 4.0-21.0 （6.33±2.70） kg, and the clinical records in hospital including eehoeardiogram operation re- cords were collected. The clinical data including the age on operation, body weight, diagnosis, anatomic type of TAPVC, the emergency event before operation, cardiopulmonary bypass time, aortic crossclamping time, were analyzed by chi- squared test and Logistic multivariable regression analysis. The risk factors influencing the early mortality of TAPVC were analyzed. Results Fifty-seven children underwent the operation, and 7 （ 12.2% ） cases died during the operation. The univariate analysis on outcomes indicated that the risk factors influencing the mortality of the operation included body weight （ P = 0.035 ） , anatomic type of TAPVC （ P = 0. 037 ） , the emergency event before operation （ P = 0.021 ） , and aortic erosselamping time（ P = 0.046）. The Logistic multivariable regression analysis indicated that the emergency events before operation was the independent risk factor for the mortality of TAPVC （ P = 0.003 ）. Conclusion TAPVC children with preoperative emergency events have higher postoperative mortality.