体-肺动脉分流术后早期死亡的危险因素分析

The risk factors analysis for the early mortality of systemic-pulmonary shunt

目的：分析影响体-肺动脉分流术后早期死亡的危险因素,以期提高手术效果.方法：2002年2月至2012年6月期间201例患者行体-肺动脉分流术,年龄3个月～13岁,体质量3.5～ 36kg.手术方法包括中央分流术（Waterston） 105例,改良Blalock-Taussig分流术（B-T分流）70例,墨尔本分流26例.回顾性分析临床资料和影响手术效果的因素.结果：术后早期死亡14例（7.0％）.单因素分析结果显示：小年龄、低体质量、室间隔完整的肺动脉闭锁、术前低血球压积、合并动脉导管未闭、术中严重低血压或心律失常、术后早期分流管道堵塞、术后急性肺水肿是术后早期死亡的危险因素,二元Logistic逐步回归分析结果显示术后早期分流管道堵塞、术后急性肺水肿是手术早期死亡的独立的危险因素.结论：体-肺动脉分流术中,选择合适大小的分流管防止术后分流管道堵塞和急性肺水肿,可以明显降低术后早期病死率,特别是小年龄和低体质量患者.

Objective：The objective was to analyze the risk factors for the early death in patients after systemic-pulmonary shunt in order to improve the operative results.Methods：Between February 2002 and June 2012,201 patients with age from 3 months to 13 years,and weight from 3.5 to 36 kg,underwent a systemic-pulmonary shunt.The surgical procedure included central aortopulmonary shunt （Waterston）in 105 patients,modified Blalock-Taussig shunt in 64 patients and Melbourne shunt in 32 patients.We reviewed the clinic data and analyze the risk factors for operative outcomes.Results：The early mortality was 7.0％.Univariate analysis revealed young age,low body weight,pulmonary/intact ventricle,preoperative low hemoglobin,patency duct arteries,severe intra-operative hypotention or arrhythmia,acute shunt blockage within the first 24 h and postoperative acute pulmonary edema as risk factors for early death.In the multivariate analysis,acute shunt blockage and postoperative acute pulmonary edema were independent risk factors of early death.Conclusion：Early outcomes after systemic-pulmonary shunt can be improved by preventing acute shunt blockage and choose suitable shunt size to decrease the morbidity of acute pulmonary edema,especially in the patients with young age and low body weight.