先天性心脏病改良Blalock-Taussig管道闭塞的危险因素分析

Risk factors for modified Blalock-Taussig shunt obstruction in patients with congenital heart disease

目的探讨先天性心脏病改良Blalock-Taussig(BT)管道闭塞的危险因素。方法行改良BT分流术患儿290例,根据术后是否发生管道闭塞分为闭塞组9例和非闭塞组281例。收集患儿临床资料,测定2组患儿术后24 h血小板计数(platelet count, PLT)、血小板分布宽度(platelet distribution width, PDW)、平均血小板体积(mean platelet volume, MPV)和血小板压积(plateletcrit, PCT);采用多因素logistic回归分析改良BT分流术后发生管道闭塞的危险因素。结果 2组患儿年龄、性别比例、身高、体质量、人造管道直径以及肺动脉闭锁、法洛四联症等其他病种比率比较差异均无统计学意义(P>0.05);闭塞组PDW[(21.03±6.37)%]和MPV[(15.12±6.59)fL]高于非闭塞组[(14.95±2.14)%、(8.03±3.17)fL](P<0.05),PLT[(210.13±26.54)×10~9/L]和PCT[(0.17±0.03)%]与非闭塞组[(197.25±28.43)×10~9/L、(0.16±0.04)%]比较差异无统计学意义(P>0.05);PDW>17%和MPV>10 fL为改良BT分流术后发生管道闭塞的独立危险因素(OR=2.442,95%CI:1.675~3.943,P=0.008;OR=2.227,95%CI:1.521~2.563,P=0.028)。结论 PDW、MPV升高是先天性心脏病患儿行改良BT分流术后发生管道闭塞的独立危险因素。

Objective To explore the risk factors for modified Blalock-Taussig(BT) shunt obstruction in patients with congenital heart disease. Methods A total of 290 children receiving modified BT shunt for congenital heart disease were divided into shunt obstruction group(n=9) and non-obstruction group(n=281). The clinical data were collected and the platelet count(PLT), platelet distribution width(PDW), mean platelet volume(MPV) and plateletcrit(PCT) were detected in 24 h after surgery in two groups. Multivariate logistic regression was used to analyze the risk factors for conduit obstruction after modified BT shunt. Results There were no significant differences in age, sex ratio, height, body mass, diameter of artificial conduit, constitutional ratio of pulmonary atresia, and constitutional ratio of tetralogy of Fallot and the other diseases between two groups(P>0.05). The PDW((21.03±6.37)%) and MPV((15.12±6.59) fL) in obstruction group were significantly higher than those in non-obstruction group((14.95±2.14)%,(8.03±3.17)fL)(P<0.05). There were no significant differences in PLT((210.13±26.54)×10~9/L vs.(197.25±28.43)×10~9/L) and PCT((0.17±0.03)% vs.(0.16±0.04)%) between obstruction group and non-obstruction group(P>0.05). PDW>17% and MPV>10 fL were the independent risk factors for conduit obstruction after modified BT shunt(OR=2.442, 95%CI: 1.675-3.943, P=0.008;OR=2.227, 95%CI: 1.521-2.563, P=0.028). Conclusion The elevated PDW and MPV are the independent risk factors for modified BT shunt obstruction in children with congenital heart disease.