小于3月龄婴儿先天性心脏病手术死亡危险度分析

Risk analysis of operative mortality in infants less than 3 months with congenital heart defects

目的:对小于3月龄先天性心脏病(先心病)手术死亡危险度进行分析。方法:回顾性分析2010-10-2013-10单中心先心病外科治疗转归。根据RACHS-1评分对手术复杂度进行分类。手术时年龄、体重、是否体外循环、体外循环时间、主动脉阻断时间、紫绀、单心室手术、术前肝肾功能异常以及RACHS-1分类均纳入风险评估。结果:小于3月龄先心病患儿手术治疗的总体死亡率为3.67%,新生儿死亡率较高,为8.47%,低体重儿死亡率为20%。新生儿的ICU时间和并发症均较高。总体来说,年龄、体重和RACHS-1分类为死亡的独立危险因素。但在新生儿中,只有RACHS-1和单心室手术为死亡的危险因素。结论:小于3月龄先心病的死亡危险因素是年龄、体重和RACHS-1评分。新生儿期单心室手术策略有待优化。

Objective： To analyze the operative mortality of congenital heart defects in infants less than 3 months. Method：We analyzed retrospectively the surgical outcomes of congenital heart defects in single center dur- ing Oct. 2010- Oct. 2013. We classified surgical procedures complexity using the Risk Adjustment in Congenital Heart Surgery （RACHS-1） score. The age, weight at operation, required CBP or not, total bypass time, cross clamp time, cyanosis before operation, single ventricle operation, liver or renal dysfunction before operation, RACHS-1 score were adopted to risk assessments. Result：OveraU mortality of congenital heart defect in infants less than 3 months was 3.67%. Mortality was 8.47~~ in neonates, and 20~ in low weight infants was 20~. Ne- onates suffered longer periods of intensive care unit and a higher morbidity. Overall, age, weight and RACHS-1 score were independent risk factors for mortality. In neonates, RACHS-1 and single ventricle operation were inde- pendent risk factors for mortality. Conclusion： The risk factors of mortality in infants less than 3 months with con- genital heart defect were age,weight and RACHS-1 score . The strategy of single ventricle operation in neonates should be optimized.