先天性心脏病术后患儿血管活性药物评分与其预后关系

Vasoactive-inotropic score as a predictor of outcome in children after cardiac surgery with bypass

目的利用血管活性药物评分对先天性心脏病体外循环术后患儿所用的血管活性药物进行评分，探讨其与患儿预后的关系。方法回顾性收集472例体外循环下行先天性心脏病手术所有患儿的临床资料，对术后第1个24h、第2个24h、第3个24h所使用的血管活性药物进行评分，计算其最大值和均值[VIS（24max）、VIS（24mean）、VIS（48max）、VIS（48mean）、VIS（72max）、VIS（72mean）]，并对血管活性药物评分和预后结局进行相关性分析。结果本研究中血管活性药物评分VIS（24max）对预后不良结局的预后判断更准确（AUROC：0．919，P=0．000），并计算出VIS（24max）对预后不良结局预测的最佳临界值为19．5分（J=0．70）。在控制了多种单因素之间的互相影响后，仅有乳酸高值、VIS（24max）与患儿的预后相关。结论在先天性心脏病术后婴幼儿中，VIS评分尤其是VIS（24max）越高，提示患儿的病情越重，治疗效果越差，死亡风险更高。

Objective To evaluate the vasoactive-inotropic score （VIS） as a predictor of outcome in children following surgery for congenital heart disease. Methods A retrospective chart review of 472 children undergoing cardiac surgery with bypass. VIS values were calculated during the first 72 postoperative hours, and the maximum and mean scores in the first, sec- ond and third 24 postoperative hours [ VIS （ 24max ）, VIS （ 24mean ）, VIS （ 48max ）, VIS （ 48mean ）, VIS （ 72max ）, VIS （72mean） ] were also recorded. Chi-test, t-test, and ROC curves were performed for the association between VIS and the clin- ical outcomes. Results ROC analysis indicated the VIS （24max） was strongly associated with poor outcomes （AUROC = 0. 919, P=0.000）. And the high VIS（24max） defined as 19.5 and above, which may lead poor outcomes（J=0.70）. When the interplay between a range of factors was controlled, only lactate and VIS （24max） was related to the prognosis. Conclusion Maximum VIS calculated in the first 24 hours[VIS（24max）] after PICU admission was strongly and significantly associated with clinical outcomes in children after cardiac surgery. The greater the VIS, the worse the illness, the poorer the outcome, the higher the mortality.