新生儿危重肺动脉瓣狭窄或闭锁术后急性肺再灌注损伤危险因素分析

Risk factors of postoperative acute pulmonary reperfusion injury in neonatal severe pulmonary stenosis or pulmonary atresia

目的探讨新生儿危重肺动脉瓣狭窄或闭锁患儿术后急性肺再灌注损伤的临床特征和危险因素。方法选择2014年2月至2018年2月本院新生儿重症监护室行经皮球囊肺动脉瓣成形术的危重肺动脉瓣狭窄或闭锁患儿进行回顾性分析。收集患儿一般特征、围手术期心脏结构、血流动力学数据及生化指标,根据患儿术后是否发生急性肺再灌注损伤分为损伤组和非损伤组。采用多元Logistic回归模型分析患儿术后急性肺再灌注损伤的危险因素。结果共纳入危重肺动脉瓣狭窄或室间隔完整型肺动脉瓣闭锁患儿32例,产前诊断24例,生后诊断8例;主要表现为气促、发绀;予以静脉输注前列腺素E维持动脉导管开放;手术日龄1~52d,中位数7.5d。术后发生急性肺再灌注损伤7例(21.9%)。损伤组术前和术中肺动脉瓣环直径、扩张球囊直径、术前血红蛋白、红细胞压积、血白蛋白水平均低于非损伤组,手术历时时间、总住院天数和术后住院天数均长于非损伤组,差异有统计学意义(P<0.05)。多元Logistic回归分析显示,肺动脉瓣环直径小(OR=5.814,95%CI1.106~30.568)、术前血白蛋白低(OR=1.361,95%CI1.063~1.742)、红细胞压积低(OR=1.173,95%CI1.010~1.363)是发生术后急性肺再灌注损伤的危险因素,差异有统计学意义(P<0.05)。结论急性肺再灌注损伤是危重肺动脉瓣狭窄或闭锁术后较常见并发症之一,肺动脉瓣环狭窄程度、术前血白蛋白水平和红细胞压积是发生术后急性肺再灌注损伤的危险因素。

Objective To study the clinical features and risk factors of acute pulmonary reperfusion injury after operation in neonates with severe pulmonary stenosis or pulmonary atresia. Method From February 2014 to February 2018, a retrospective analysis was performed in patients with critical pulmonary stenosis or pulmonary atresia who received percutaneous balloon pulmonary valvuloplasty (PBPV) in the neonatal intensive care unit of our hospital. Clinical characteristics, perioperative cardiac structure, hemodynamic data and biochemical results were collected. The neonates were assigned into injury group if they had acute lung reperfusion injury, and non-injury group if not. The risk factors of acute lung reperfusion injury were analyzed using multi-variate Logistic regression model. Result A total of 32 patients (24 prenatal diagnosis and 8 postnatal diagnosis) with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum were enrolled. The main manifestations were dyspnea and cyanosis. Intravenous prostaglandin E was administered to keep the ductus arteriosus open. The age of operation ranged from 1 to 52 days and the median age was 7.5 days. Postoperative acute lung reperfusion injury occurred in 7 cases (21.9%). Preoperative and intraoperative pulmonary valve annulus diameter, balloon diameter, preoperative hemoglobin, hematocrit and blood albumin were significantly lower in the injury group. The operation duration, total length of hospital stay and postoperative duration were longer than in the non-injury group, the differences were statistically significant (P<0.05). Multi-variate Logistic regression analysis showed that the diameter of pulmonary valve annulus (OR=5.814, 95%CI 1.106~30.568), preoperative blood albumin (OR=1.361, 95%CI 1.063~1.742), and hematocrit (OR=1.173, 95%CI 1.010~1.363) were risk factors of acute lung reperfusion injury, with statistically significant differences (P<0.05). Conclusion Acute lung reperfusion injury is one of the common complications after the operation of severe pulmonary stenosis or pulmonary atresia. The severity of pulmonary valve annulus stenosis, preoperative hematocrit and blood albumin level may be the risk factors of postoperative acute lung reperfusion injury.