血流动力学改变预测法洛四联症根治术后毛细血管渗漏综合征的相关研究

Predictive effect of hemodynamic changes on capillary leakage syndrome after radical operation of tetralogy of fallot

目的通过监测法洛四联症根治术后患儿血流动力学的改变,预测毛细血管渗漏综合征的发生状况,为提高法洛四联症根治术的治疗效果提供理论依据。方法选取2016年12月至2017年12月在首都医科大学附属北京安贞医院小儿心脏中心行法洛四联症根治术的44例患儿为研究对象,根据术后是否发生毛细血管渗漏综合征分为渗漏组和非渗漏组,各22例。采用Mostcare监测仪监测并记录切开皮肤后(T_0)、切开心包后(T_1)、拔除主动脉插管后(T_2)、术后离室前(T_3)血流动力学指标变化,筛选与毛细血管渗漏综合征发生较为敏感的血流动力学指标,并拟合预测方程。结果渗漏组阻断时间、体外循环时间均明显长于非渗漏组[(70±15)min比(62±10)min、(96±15)min比(86±11)min],差异均有统计学意义(均P<0.05)。渗漏组T_2时点舒张压、T_3时点外周血管阻力、T_2时点每搏输出量明显高于非渗漏组,T3时点左心室收缩末期弹性、T_2及T_3时点左心室-动脉偶联明显低于非渗漏组,差异均有统计学意义(均P<0.05)。Logistic回归分析结果表明,体外循环时间、T_2时点舒张压和T_2时点每搏输出量为预测术后毛细血管渗漏综合征发生较为敏感的指标,优化后的预测方程为:P=1/[1+e^(-(-15.437+0.075x_1+0.085x_2+0.483x_3))],其中x_1至x_3分别表示术中体外循环时间、T_2时点舒张压、T_2时点每搏输出量,优化后方程整体预测准确率为77.3%。结论血流动力学指标对法洛四联症根治术后患儿发生毛细血管渗漏综合征能起到较好的预测作用。

ObjectiveTo observe the hemodynamic changes in children after radical operation of tetralogy of fallot and to discuss the occurrence of capillary leakage syndrome. MethodsForty-four children undergoing radical operation of tetralogy of fallot from December 2016 to December 2017 in Beijing Anzhen Hospital, Capital Medical University were enrolled; capillary leakage syndrome occurred in 22 children after operation（leakage group） and 22 children did not have postoperative complication（no-leakage group）. Hemodynamic parameters were recorded after incision（T0）, after pericardium cut（T1）, after removal of aortic cannula（T2） and at the end of operation（T3） using the Mostcare monitor. Hemodynamic factors related to capillary leakage syndrome were analyzed to obtain the forecasting equation. ResultsAortic cross-clamp time and cardiopulmonary bypass time in leakage group were significantly longer than those in no-leakage group[（70±15）min vs （62±10）min, （96±15）min vs （86±11）min]（P〈0.05）. Diastolic pressure at T2, systemic vascular resistance at T3 and stroke output at T2 in leakage group were significantly higher than those in no-leakage group; left ventricular end-systolic elasticity at T3, left ventricular-artery coupling at T2 and T3 in leakage group were significantly lower than those in no-leakage group（all P〈0.05）. Logistic regression analysis showed that cardiopulmonary bypass time（x1）, diastolic pressure（T2）（x2） and stroke output（T2）（x3） were sensitive predictors of capillary leakage syndrome; the predictive equation was P=1/[1＋e-（-15.437＋0.075x1＋0.085x2＋0.483x3）]; the predictive accuracy of the equation was 77.3%. ConclusionHemodynamic parameters show good value in prediction of postoperative capillary leakage syndrome in children with radical operation of tetralogy of fallot.