改良Fontan手术的危险因素分析

The analysis of risk factors for the modified Fontan operation

目的 探讨改良Fontan手术后早期死亡的危险因素和手术适应证。方法 统计分析 1 54例改良Fontan手术病人的 1 7个围手术期指标与手术结果。结果 术后早期死亡 37例 ,死亡率 2 4 0 %。单因素分析结果表明 ,术前McGoon比值≤ 1 8、术前房室瓣存在反流、手术方式、术后右房压≥ 2 0mmHg、心律失常、严重低心输出量综合征是手术早期死亡的高危因素。多因素Logistic逐步回归分析结果显示 ,手术方式 (右房与右室连接、右房与肺动脉连接 )、术后右房压和术后严重低心输出血量综合征与术后早期死亡有关。结论 术前严格选择心室功能和肺动脉发育好、无明显房室瓣反流的病例 ,采用全腔静脉与肺动脉连接术式 。

Objective: To determine the risk factors of early postoperative death associated with the modified Fontan operation. Methods: We analyzed 17 perioperative variables in 154 patients received the modified Fontan operation, and identified the risk factors affecting the early postoperative death. Results: The early operative mortality rate was 24.0% (37/154). Preoperative McGoon ratio, preoperative atrioventricular valve insufficiency, surgical mode, high postoperative right atrial pressure (≥20 mm?Hg), postoperative arrhythmias and postoperative severe low cardiac output syndrome were risk factors for the modified Fontan operation by univariately analysis. Surgical mode, high postoperative right atrial pressure (≥20 mm?Hg) and postoperative severe low cardiac output syndrome were related with the early postoperative death by multiple logistic discriminant analysis. Conclusion: Conclusion: Proper selection of patients, use of total cavopulmonary connection and appropriate postoperative care may improve the outcome of the modified Fontan operation.