介入治疗对先天性心脏病患儿心肌损伤的影响因素分析

Influencing factors of myocardial damage in congenital heart disease interventional treatment

目的探讨介入治疗对先天性心脏病患儿心肌损伤的影响因素。方法纳入南华大学附属怀化医院行介入治疗的99例患儿作为研究对象,测定患儿心肌肌钙蛋白I(c Tn I)的水平,并以此判断患儿心肌损伤的严重程度,根据回归分析方法,分析各危险因素与心肌损害的关系。结果99例先天性心脏病患儿中c Tn I<0.1 ng/ml有24例,c Tn I≥0.1 ng/ml有75例。分析介入治疗对患儿心肌损伤的影响因素发现,年龄[(8.2±2.0)岁比(6.2±1.4)岁,P=0.008]、体重[(8.9±3.0)kg比(6.0±3.0)kg,P=0.025]、手术时间[(45.3±16.8)min比(105.2±37.1)min,P<0.001]、封堵器大小[(5.3±3.3)mm比(9.0±6.1)mm,P<0.001]、血红蛋白差值[(8.0±2.9)g/L比(6.6±1.4)g/L,P=0.009]、封堵器释放次数[(1.3±1.2)次比(3.0±0.8)次,P<0.001]、肺动脉压力[(30.6±10.2)mm Hg比(35.4±12.4)mm Hg,P=0.004](1 mm Hg=0.133 k Pa)及对比剂总量[(1.2±0.6)ml/kg比(2.6±1.0)ml/kg,P<0.001]能影响先天性心脏病患儿的心肌受损。多因素Logistic回归分析显示,患儿体重、手术时间、封堵器大小、封堵器释放次数和对比剂总量与心肌损伤相关,OR值分别为2.250、1.629、1.704、3.579(P均<0.05)。结论体重、手术时间、封堵器大小、封堵器释放次数和对比剂总量是介入治疗影响先天性心脏病患儿心肌损伤的独立危险因素。

Objective To explore influencing factors of myocardial damage in congenital heart disease interventional treatment. Methods Transcatheter intervention of 99 cases of congenital heart disease were performed and the severity of myocardial injury was determined according to the levels of cardiac troponin I（ c Tn I） in patients. The risk factors of myocardial damage were analyzed with single factor analysis and Logistic regression. Results The level of c Tn I increased after operation in 75 cases,while remained normal in another 24 cases. Single factor analysis indicated that age [（ 8. 2 ± 2. 0） years old vs.（ 6. 2 ±1. 4） years old,P = 0. 008],body weight [（ 8. 9 ± 3. 0） kg vs.（ 6. 0 ± 3. 0） kg,P = 0. 025],operative time [（ 45. 3 ± 16. 8） min vs.（ 105. 2 ± 37. 1） min,P〈 0. 001],occluder size [（ 5. 3 ± 3. 3） mm vs.（ 9. 0 ± 6. 1） mm,P〈0. 001],hemoglobin difference [（ 8. 0 ± 2. 9） g/L vs.（ 6. 6 ± 1. 4） g/L,P =0. 009],pulmonary artery pressure [（ 30. 6 ± 10. 2） mm Hg vs.（ 35. 4 ± 12. 4） mm Hg,P = 0. 004]（ 1 mm Hg = 0. 133 k Pa）,number of times of releasing the occluders [（ 1. 3 ± 1. 2） vs.（ 3. 0 ± 0. 8）,P 0. 001] and the total amount of contrast agent used [（ 1. 2 ± 0. 6） ml / kg vs.（ 2. 6 ± 1. 0） ml / kg,P 0. 001] all affected myocardial damage in patients with congenital heart disease. Multivariate logistic regression analysis showed that the weight of patients operation time,the occluder size,the number of times of releasing the occluders and amount contrast agents used were associated with myocardial injury. The OR values were 2. 250,1. 629,1. 704 and 3. 579 respectively（ all P〈0. 05）. Conclusions Weight,operative time,the size of the occluder,number of times of releasing the occluders and amount of contrast agent used are an independent risk factors of myocardial injury in children with congenital heart disease receiving interventional therapy.