新生儿改良Blalock-Taussing分流术后疗效的影响因素

Analysis of the influencing factors of surgical effect for Blalock-Taussig shunt in congenital heart disease during neo-natal period

目的分析新生儿期改良Blalock-Tausing分流术后手术疗效的影响因素，总结治疗经验，以期提高手术疗效。方法回顾性分析2010年1月至2016年12月的42例新生儿行改良Blalock．Tausing术，年龄（12．3±8．0）天（1～29天），体质量（3．2±0．4）kg（2．3-4．1kg）。附带手术方式保留动脉导管未闭开放3例，右心室减压手术（肺动脉闭式扩张／跨瓣环补片）12例，B．T管道环缩2例，动脉导管未闭环缩1例。结果12例院内死亡，占28．6％（12／42）。单因素分析结果显示低体质量、术前等待时间、术前代谢性酸中毒（代酸）／休克、术中肺血来源多样化、管道／体质量、术后正性肌力药物评分（Is）高剂量以及术后非计划性干预是术后早期死亡的危险因素；二元logistic逐步回归结果显示术前代酸／休克、管道／体质量、IS是手术早期死亡的独立危险因素。结论新生儿改良Blalock-Taussing术后病死率高。维护术前状态，及时手术干预，选择合理管道大小，术后循环状态稳定可以明显降低术后早期病死率。

Objective To analyze the influencing factors of surgical management for Blalock-Taussig shunt during neo- natal period, and to summarize the clinical experience, therefore, to improve the surgical outcome. Methods The clinical da- ta between Jan 2011 and Dec 2016 were reviewed, 42 neonates （：26 males, 16 females）with the mean age from 1 to 29 days, and weight from 2.3 to 4.1 kg, underwent a Blalock-Taussig shunt. The additional operation included PDA retention in 3 pa- tients, right ventricular outflow tract retention in 12 patients, B-T conduit banding in 2 patients and PDA banding in 1 patient. Results The early mortality was 28.6% （ 12/42 ）. Univariate analysis revealed low birth weight, waiting time for surgery, pre- operative acidosis or cardiac shock, dual pulmonary blood supply, conduit/weight, high IS（ inotropic drugs score）, unplanned intervention as risk factors for early death. In the multivariate analysis, preoperative acidosis or cardiac shock, conduit/weight, high IS were independent risk factors of early death. Conclusion The mortality rate after the neonatal modified Blalock-Taus- sig shunt remains high. It can be improved by proper perioperative treatment, immediate surgical treatment and choose suitable conduit size, maintain the stable circulation.