体重不大于2．5kg的先天性心脏病患儿外科治疗结果及手术危险因素分析

Outcomes and risk factors for mortality in low-weight neonates or small infants with congenital heart diseases

目的总结体重等于或小于2.5 kg的先天性心脏病（先心病）患儿外科治疗的近、中期结果；探讨体重等于或小于2.5 kg的先心病患儿外科治疗的危险因素。方法收集我院2011年1月到2016年12月手术治疗的体重不大于2.5 kg的先心病患儿病历资料，并对这些病例进行随访。按RACHS-1分组病例，将术前潜在的风险因子与住院手术死亡进行单因素相关性分析和多因素相关性分析。将全部病例及按RACHS-1分组的各组病例分别用Kaplan-meier法做出术后生存曲线，对这些生产曲线用Log-rank法进行总体性差异检验，再对各组间的差异性进行检验。结果手术81例，手术死亡19例，手术病死率23.46%；随访死亡11例，术后1、3、5年生存率分别为65%、63%、58%。单因素分析和多因素分析均显示：与手术死亡有显著相关性的潜在风险因子是：手术时年龄（天数）、术前机械通气、术前酸中毒、姑息性手术。RACHS-1各组术后生存曲线总体上差异没有统计学意义，各组间差异性也不显著。结论①2.5 kg及以下先心病患儿能够成功进行先心病外科治疗，但有较高手术病死率，中期随访仍然有一定的病死率，值得我们重视；②手术时年龄、术前机械通气、术前酸中毒、姑息性手术是2.5 kg及以下先心病患儿手术死亡的独立风险因子；③不同RACHS-1分级的2.5 kg及以下先心病手术后中期生存率差别不大。

ObjectiveTo explore the outcomes and risk factors for hospital mortality in low-weight neonates or small infants with congenital heart diseases.MethodsRetrospective analysis were performed for low-weight neonates or small infants with congenital heart diseases during January 2011 and December 2016. Different groups were divided according to the criteria of RACHS-1. Single and multiple-factor correlations were analyzed between operative mortality and potential operative risk factors. Postoperative survival curves were plotted for all patients and those in different RACHS-1 ranks by Kaplan-Meier method, then differences between these curves were analyzed by Log-rank test.ResultsAmong them, 81 low-weight neonates or small infants had an operative mortality of 19/81（23.46%） while another 11 died during follow-ups. And 1, 3, 5-year postoperative survival rates were 65%, 63% and 58% respectively. Both single-factor correlative and Logistic analyses indicated that operative age （days）, preoperative mechanical ventilation, preoperative acidosis and palliative operation were correlated significantly with operative mortality. No significant difference existed in overall and individual comparisons of postoperative survival curves of different RACHS-1 groups.ConclusionsCongenital heart diseases may be treated surgically in low-weight neonates or small infants. However, hospital mortality remains high. Operative age, preoperative mechanical ventilation, preoperative acidosis and palliative operation are independent operative risk factors for hospital mortality among low-weight neonates or small infants with congenital heart diseases. No significant difference exists in median-term survival rate among different RACHS-1 groups.