婴幼儿法洛四联症一期根治术后重症监护室滞留的危险因素分析

ARisk factors for prolonged stay in intensive care unit in infants with tetralogy of Fallot undergoing corrective surgery

目的探讨婴幼儿法洛四联症(tetralogy of Fallot,TOF)一期根治术后重症监护室(ICU)滞留的危险因素。方法回顾性分析武汉亚洲心脏病医院2015年1月至2019年12月收治的215例法洛四联症行一期根治术患儿的临床资料,根据术后ICU时间分为滞留组46例(ICU时间≥7 d)和对照组169例(ICU时间<7 d),比较两组患儿围术期相关资料。多因素logistic回归分析TOF一期根治术后ICU滞留的危险因素。结果两组患儿在年龄(P=0.003)、体重(P=0.002)、左心室舒张末期容积指数(LVEDVI,P=0.001)、McGoon比值(P<0.001)、Nakata指数(P=0.042)、升主动脉与主肺动脉直径比值(AO/PA,P=0.012)、跨瓣环补片(P=0.022)和体外循环时间(P<0.001)、主动脉阻断时间(P<0.001)、机械通气时间(P<0.001)及术后并发症(P<0.001)方面均存在统计学差异,logistic回归分析结果提示,体外循环时间>120 min[P<0.05,OR=3.445(1.241~9.561)]、体重低于8 kg[P<0.05,OR=2.802(1.103~7.120)]和术后并发症[P<0.01,OR=7.660(3.464~16.941)]是TOF患儿一期根治术后ICU滞留的危险因素。结论体外循环时间延长、低体重及术后出现并发症是TOF患儿一期根治术后ICU滞留的危险因素。

Objective To evaluate the risk factors for prolonged stay in intensive care unit(ICU)after primary radical surgery of tetralogy of Fallot(TOF)in infants.Methods The clinical data of 215 patients with tetralogy of Fallot who were admitted to Wuhan Asian Heart Hospital from January 2015 to December 2019 for primary radical surgery were retrospectively analyzed.The patients were divided into the prolonged stay group(46 patients with ICU time≥7 days)and the control group(169 patients with ICU time<7 days)based on the length of stay in ICU.Perioperative clinical data were compared between the two groups.Multivariate logistic regression was performed to analyze the risk factors for prolonged stay in ICU with tetralogy of Fallot after primary radical surgery.Results Age(P=0.003),body mass(P=0.002),left ventricular volume index(LVEDVI,P=0.001),McGoon ratio(P<0.001),Nakata index(P=0.042),the ratio of the diameter of aorta to pulmonary artery(AO/PA,P=0.012),presence of transvalvular annulus patch(P=0.022),cardiopulmonary bypass time(P<0.001),aortic clamping time(P<0.001),mechanical ventilation time(P<0.001)and postoperative complications(P<0.001)were different significatively between the two groups.Logistic regression analysis indicated that cardiopulmonary bypass time>120 min(P<0.05,OR=3.445[1.241~9.561]),body mass<8 kg(P<0.05,OR=2.802[1.103~7.120])and postoperative complications(P<0.01,OR=7.660[3.464~16.941])were the risk factors for prolonged stay in ICU after primary radical surgery of TOF infants.Conclusion Prolonged cardiopulmonary bypass time,low body mass and postoperative complications are the risk factors for prolonged stay in ICU after primary radical surgery of TOF infants.