TGA合并非限制性VSD或TBA超龄患儿外科手术治疗效果及影响因素分析

Analysis of Therapeutic Effect and Influencing Factors of TGA in Over-age Children with Nonrestrictive VSD or TBA

目的:观察完全型大动脉转位(TGA)合并非限制性室间隔缺损(VSD)或Taussing–Bing畸形(TBA超龄患儿行大动脉调转手术(ASO)的治疗效果,并分析其影响因素。方法:回顾性分析郑州大学附属儿童医院2015年1月至2021年1月收治的60例TGA合并非限制性VSD或TBA的年龄> 6个月的超龄患儿资料,所有患儿均行ASO治疗,根据术后1年内病死情况将患儿分为死亡组、存活组,比较两组患儿基线资料、围手术期指标及疗效,采用logistic回归分析影响疗效的因素。结果:7例患儿术后死亡,术后1年内病死率11.67%,其中包含院内死亡6例(10.00%),随访中死亡1例(1.67%);死亡组患儿的术后机械通气时间、入重症监护室(ICU)时间、总住院时间显著长于存活组,术后并发症率显著高于存活组,差异均具有统计学意义(P <0.05);两组患儿术后肺动脉平均压(MPAP)、肺/体循环压力比(P/S PR)均显著低于同组术前水平,动脉血氧饱和度(SpO_(2))均显著高于同组术前水平;死亡组患儿术前SpO_(2)显著低于存活组,术后MPAP、术前及术后P/S PR均显著高于存活组,差异均具有统计学意义(P <0.05);多因素logistic回归分析结果显示,术前SpO_(2)为TGA合并非限制性VSD或TBA超龄患儿外科手术治疗效果欠佳的独立保护因素,而术后MPAP、术前及术后P/S PR为独立危险因素。结论:ASO能有效改善TGA合并非限制性VSD或TBA超龄患儿缺氧情况、循环功能、心功能,而患儿的术前SpO_(2)、术后MPAP、术前及术后P/S PR为其治疗效果欠佳的独立影响因素。

Objective To observe the therapeutic effect of complete transposition of great arteries(TGA) combined with unrestricted ventricular septal defect(VSD) or Taussig-Bing anomaly(TBA) in over-age children undergoing arterial switch operation(ASO), and analyze its influencing factors. Methods The data of 60 over-age children with TGA combined with unrestricted VSD or TBA, aged > 6 months, admitted to the Children’s Hospital Affiliated to Zhengzhou University from January 2015 to January 2021 were reviewed. All children were treated with ASO, and were divided into death group and survival group according to their mortality within 1 year after surgery. Baseline data, perioperative indexes and curative effect were compared between the two groups, and factors influencing curative effect were analyzed by logistic regression. Results 7 cases died after surgery, the mortality rate within 1 year after surgery was 11.67 %, including 6 cases died in hospital(10.00 %) and 1 case died during follow-up(1.67 %). The postoperative mechanical ventilation time, ICU time and total hospital stay in the death group were significantly longer than those in the survival group, and the postoperative complication rate was significantly higher than that in the survival group, the differences were statistically significant(P < 0.05). Postoperative mean pulmonary arterial pressure(MPAP) and pulmonary blood pressure/systemic blood pressure(P/S PR) were significantly lower than the preoperative levels of the two groups, and arterial oxygen saturation(SpO_(2)) was significantly higher than the preoperative level in the two groups. Preoperative SpO_(2)in the death group was significantly lower than that in the survival group, and postoperative MPAP, P/S PR before and after surgery were significantly higher than those in the survival group, the differences were statistically significant(P < 0.05). Multivariate logistic regression analysis showed that preoperative SpO_(2)was an independent protective factor for poor surgical outcomes in over-age children with TGA combined with non-restrictive VSD or TBA, while postoperative MPAP, preoperative and postoperative P/S PR were independent risk factors. Conclusion ASO can effectively improve hypoxia, circulatory function and cardiac function in over-aged children with TGA combined with non-restrictive VSD or TBA, while preoperative SpO_(2), postoperative MPAP, preoperative and postoperative P/S PR are independent influencing factors for poor therapeutic effect.