乌司他丁对接受室间隔缺损修补术婴儿预后影响的研究

Effects of Ulinastatin in Infants undergoing Repair Surgery for Ventricular Septal Defect

目的本研究拟在评价乌司他丁对接受室间隔缺损(ventricular septal defect,VSD)婴儿术后不良事件发生率和死亡率的近期与远期影响。方法采取回顾性队列研究,连续选取本院2009年1月至2010年12月接受VSD修补术的单纯VSD婴儿357名,根据术中是否应用乌司他丁被分乌司他丁组(n=203)和对照组(n=154),年龄31天至1岁,美国麻醉师协会分级为2~3级;在术后第8年对患儿及其家属进行电话随访。记录并统计分析患儿术后近远期不良事件的发生率和死亡率。结果与对照组比较,乌司他丁组的术后总出血量显著减少,差异有统计学意义[(13.965±7.657)ml/kg vs(12.665±6.858)ml/kg,P<0.05)。两组患者间术后血红蛋白水平的最大值、术后血制品的输注量、术后机械通气时间、ICU停留时间、术后住院时间、术后肌酐水平的最大值以及术后近远期肾功能衰竭发生率和死亡率的差异无统计学意义(P>0.05)。结论乌司他丁可显著降低婴儿心脏术后的总出血量,对近、远期不良事件的发生率和死亡率没有影响。

Objective To evaluate the effects of ulinastatin in infants undergoing repair surgery for ventricular septal defect(VSD).Methods This was a retrospective cohort study.During January 2009 to December 2010,357 consecutive patients aged from 31 days to 1 years old receiving repair surgery for VSD in Fuwai hospital were enrolled in the study.They were divided into two groups:the control group(n=154)and the ulinastatin group(n=203).Patients and their families were followed up by telephone at 8 years after surgery.The short-term and long-term morbidity and mortality were recorded and analyzed.Results Compared with the control group,the patients in the ulinastatin group were associated with significant decreased postoperative total blood loss([13.965±7.657]ml/kg vs[12.665±6.858]ml/kg,P<0.05).There were no significant differences in the postoperative level of hemoglobin,postoperative allogeneic transfusion,mechanical ventilation time,postoperative ICU stay,postoperative hospital length of stay,postoperative level of creatinine,the incidence of both the short-term and long-term renal failure and death between the two groups(P>0.05).Conclusion Ulinastatin significantly decreased postoperative blood loss,but had little impact on the short-term and long-term morbidity and mortality in infants undergoing repair surgery for VSD.