完全性肺静脉异位引流术后早期死亡危险因素

Risk factors of early postoperative mortality in total anomalous pulmonary venous connection

目的 分析完全性肺静脉异位引流（TAPVC）患儿术后早期（术后30 d内）死亡的危险因素。方法 回顾性分析首都医科大学附属北京安贞医院2011年1月至2015年12月诊断为TAPVC行一期根治手术的187例患儿的临床资料。根据患儿术后早期死亡情况分为死亡组（11例）和存活组（176例）。对比死亡组与存活组患儿术前、术中及术后各项变量指标，再将有意义的变量纳入Logistic回归分析，评估TAPVC术后早期死亡的危险因素。结果 187例患儿中，术后早期死亡11例（5.9%），其中有4例为混合型肺静脉异位引流，低心排血量综合征是死亡组患儿主要的并发症，有6例。死亡组与存活组患儿的解剖分型（P=0.024）、术前脉搏血氧饱和度（P=0.020）、术前左心室舒张末期内径（P=0.024）、术前肺静脉最大流速（P=0.046）、术前肺动脉压力（P=0.010）、阻断升主动脉时间（P〈0.001）、术中体外循环时间（P〈0.001）、术后左心室射血分数（P=0.003）、术后左心室舒张末期内径（P=0.010）、术后肺静脉最大流速（P=0.010）、术后正性肌力药物评分（P〈0.001）、术后左心房压力（P=0.001）差异均有统计学意义。Logistic回归后退法分析结果显示，体外循环时间（比值比=1.017,P=0.049）和术后正性肌力药物评分（比值比=1.119, P=0.032）为术后早期死亡的危险因素。结论 体外循环时间和正性肌力药物评分是TAPVC术后早期死亡的独立危险因素。

Objective To analyze risk factors of early postoperative mortality in total anomalous pulmonary venous connection（TAPVC）. Methods Totally 187 children who underwent one-stage radical operation for TAPVC in Beijing Anzhen Hospital, Capital Medical University were respectively enrolled from January 2011 to December 2015. Eleven children died in 30 d after operation. Operation related indexes were analyzed between death group（11 cases） and survival group（176 cases）. Risk factors of early postoperative mortality were analyzed by logistic regression analysis. Results The early mortality rate was 5.9%（11/187）, including 4 cases of mixed TAPVC; low cardiac output （6 cases） was the main complication in death group. There were statistical significances regarding diagnostic type（P=0.024）, preoperative blood oxygen saturation（P=0.020）, left ventricular end-diastolic diameter（P=0.024）, pulmonary vein velocity（P=0.046）, pulmonary artery pressure（P=0.010）, ascending aorta blocking time（P〈0.001）, intraoperative cardiopulmonary bypass（CPB） time（P〈0.001）, postoperative left ejection fraction（P=0.003）, left ventricular end-diastolic diameter（P=0.010）, pulmonary vein maximum velocity（P=0.010）, positive inotropic drug score（P〈0.001） and left atrial pressure（P=0.001） between groups. Backward logistic regression analysis suggested that CPB time（odds ratio=1.017,P=0.049） and positive inotropic drug score（odds ratio=1.119, P=0.032） were independent risk factors of early mortality after operation. Conclusion CPB time and positive inotropic drugs score are independent risk factors of postoperative early mortality of TAPVC.