主动脉缩窄外科手术后患者早期高血压的危险因素分析

Risk factors of early hypertension in patients after aortic coarctation surgery

目的分析主动脉缩窄(COA)外科手术后患者早期高血压的发生情况和危险因素。方法收集2010年1月至2020年12月首都医科大学附属北京安贞医院小儿心脏中心行外科手术治疗的203例COA患者的临床资料,根据有无术后早期高血压分为高血压组(136例)和非高血压组(67例)。比较2组患者临床资料,分析COA术后早期高血压的危险因素。结果高血压组患者手术年龄明显高于非高血压组[1.3(0.6,4.0)岁比0.6(0.4,1.1)岁](P<0.001),术前缩窄处压差明显高于非高血压组(P=0.046),术前合并心内分流比例明显低于非高血压组(P=0.023)。高血压组术后吻合口压差高于非高血压组,但组间差异无统计学意义(P=0.092)。Logistic回归分析结果显示,手术年龄是行外科手术治疗的COA患者术后早期高血压的独立危险因素(比值比=0.753,95%置信区间:0.599~0.945,P=0.015)。结论手术年龄是COA外科手术后患者早期高血压的危险因素。

Objective To investigate the occurrence and the risk factors of early hypertension in patients after aortic coarctation(COA)surgery.Methods Clinical data of 203 patients with COA who underwent surgery in Pediatric Cardiac Center,Beijing Anzhen Hospital,Capital Medical University from January 2010 to December 2020 were collected.The patients were divided into hypertensive group(HBP group,136 cases)and non⁃hypertensive group(non⁃HBP group,67 cases)according to the presence of early postoperative hypertension.Clinical data of the two groups were compared,and the risk factors of early hypertension after COA surgery were analyzed.Results Operative age of patients in HBP group was significantly higher than that in non⁃HBP group[1.3(0.6,4.0)years vs 0.6(0.4,1.1)years](P<0.001),and preoperative pressure difference at stenosis in HBP group was significantly higher than that in non⁃HBP group(P=0.046).Preoperative intracardiac shunt rate in HBP group was significantly lower than that in non⁃HBP group(P=0.023).Postoperative pressure difference at stenosis in HBP group was higher than that in non⁃HBP group,but the difference between groups was not statistically significant(P=0.092).Logistic regression analysis showed that operative age was an independent risk factor of early hypertension in patients after COA surgery(odds ratio=0.753,95%confidence interval:0.599⁃0.945,P=0.015).Conclusion Operative age is a risk factor of early hypertension in patients after COA surgery.