西藏先天性心脏病患儿在低海拔地区行手术麻醉的围手术期安全性

Perioperative safety of Tibetan children with congenital heart disease undergoing cardiac surgery and anesthesia in low-altitude area

目的:观察高海拔地区先天性心脏病患儿到低海拔地区行先天性心脏病矫治手术的临床指标和短期预后,以探讨其围手术期的安全性。方法:回顾性分析2016年1至12月在中南大学湘雅医院择期行先天性心脏病矫治手术的来自西藏自治区(X组)和湖南省(H组)的患儿各7例。比较两组患儿心脏超声心动图检查指标、围手术期血流动力学、术后恢复与并发症和围手术期氨基末端脑钠肽前体(N terminal pro B type natriuretic peptide,NT-proBNP)水平。结果:心脏超声心动图显示两组患儿心脏结构和心功能无明显差异,X组患儿肺高压的发生率明显高于H组(P<0.05)。围手术期血流动力学比较两组之间差异无统计学意义(P>0.05),术后ICU停留时间X组患儿更长(P<0.05)。血清NT-proBNP水平X组患儿明显高于H组(P<0.05)。结论:高海拔地区的先天性心脏病患儿到低海拔地区行先天性心脏病矫治手术有助于提高围手术期安全性,麻醉手术中血流动力学平稳,但术后心功能不全风险仍高于低海拔地区患儿,术后恢复时间延长。

Objective： To observe the clinical parameters and short-term prognosis of Tibetan high-altitude area children with congenital heart disease undergoing surgery and anaesthesia in low-altitude area, and to investigate the perioperative safety of the treatment. Methods： From January, 2016 to December, 2016, 14 children with congenital heart disease who underwent surgery were assigned into 2 groups （n=7 each）： the high-altitude area group （X group, children from Tibetan Autonomous Region） and the low-altitude area group （H group, children from Hunan Province）. Echocardiography data, perioperative hemodynamic changes, postoperative recovery, complication and perioperative serum N terminal pro B type natriuretic peptide （NTproBNP） levels were recorded. Results： There were no significant differences in cardiac structure and function between the 2 groups, while the incidence of pulmonary hypertension in the X group was significantly higher than that in the H group （P〈0.05）. There were no significant differences in perioperative hemodynamics between the 2 groups （P〉0.05）, while the duration in ICU in the X group was longer than that in the H group and the serum NT-proBNP level in the X group was higher than that in the H group （P〈0.05）. Conclusion： For children with congenital heart disease in Tibetan high-altitude area, undergoing surgery in low-altitude area contributes to a steady perioperative hemodynamics and helps to increase the perioperative safety. There may be a higher risk of postoperative cardiac dysfunction in Tibetan children than that in low-altitude area.