完全性肺静脉异位引流患者术后流速和吻合口大小与早中期预后的关系

Association of size and velocity of blood flow of the anastomosis and prognosis in patients with total anomalous pulmonary venous connection

目的本文通过回顾性总结单中心数据,分析患者术后早期复查吻合口的大小以及流速与完全性肺静脉异位引流（total anomalous pulmonary venous connection,TAPVC）早中期外科疗效的关系。方法回顾性入选2006年1月1日至2013年12月31日在广东省人民医院行外科矫治术的所有TAPVC患者共328例,通过查阅病历收集患者术前、术后的临床资料并随访至2015年5月。患者早期吻合口的情况为术后住院期间进行第一次超声心动图复查记录的吻合口直径（单位为mm）及流速（单位为m/s）;吻合口大小校正值=吻合口大小绝对值/体表面积;观察的终点为术后死亡以及肺静脉梗阻（pulmonary venous obstruction,PVO）。结果患者术后早期吻合口大小的绝对值与流速成负相关（spearman：r=-0.316,P=0.00）。经过校正不同TAPVC分型、术前PVO及新生儿的因素,COX比例风险模型评估提示,吻合口大小的绝对值和校正值都与术后PVO负相关（OR=0.73,OR=0.93）,差异具有统计学意义;吻合口大小与术后死亡也呈负相关关系。吻合口流速与术后PVO和死亡呈正相关关系,以0.5 m/s为一个递增单位,OR（95%CI）分别是13.76（7.59~24.92）和3.04（1.72~5.39）。结论术后早期吻合口增大与术后PVO和死亡发生风险降低有关,而流速增快则与风险明显增高有关。

Objectives To evaluate the association of size and velocity of blood flow of the anastomosis and prognosis in patients with total anomalous pulmonary venous connection（TAPVC）. Methods From January 2006 to December2013, 328 consecutive patients with TAPVC receiving surgical treatment in Guangdong General Hospital were enrolled in this study. Clinical records of all the patients were reviewed. Study eligibility variables were extracted from the clinical records. Follow-up was conducted at an interval of 1 month, 3 months, 6 months and 12 months post-operation until May 2015. The early size and velocity of blood flow of the anastomosis between the pulmonary venous confluence and the left atrium were routinely evaluated during hospital stay post-operation. The absolute value（mm）and standardized value（mm / m^2） were applied in the measurement of the size of the anastomosis. The standardizedvalue of the anastomotic size was calculated by the absolute value divided by body surface area. Study endpoints was defined by postoperative total death or pulmonary venous obstruction（PVO）. Results The absolute value of the anastomosis in early postoperative stage was negatively related to the velocity of the blood flow（spearman ： r =-0.316,P =0.00）. With adjustments of different subtypes of TAPVC, pre-operational PVO and newborn, Cox proportional hazards regression model suggested that the absolute and standardized values of the anastomotic size were inversely associated with post-operational PVO [OR（95%CI） ： 0.73（0.58-0.92） and 0.93（0.87-1.00） ]. The absolute value was also negatively associated with post-operational mortality. The velocity of the blood flow was positively associated with post-operational PVO and death, the OR（95% CI） for each 0.5 m / s increment were 13.76（7.59-24.92） and3.04（1.72-5.39）. Conclusions The early size and velocity of blood flow of the anastomosis may be valuable indexes to suggest adverse prognosis of TAPVC. The size of the anastomosis was negatively, while the velocity of the blood flow was positively associated with post-operational PVO and mortality.