先天性心脏病再次手术患者外周插管建立体外循环效果的回顾性队列研究

Effect of peripheral cannulation for cardiopulmonary bypass in patients with congenital heart disease undergoing reoperation:A retrospective cohort study

目的评估先天性心脏病再次手术患者外周插管建立体外循环方式的安全性和有效性。方法回顾性分析2019—2020年在阜外医院接受再次手术的先天性心脏病患者的围手术期资料,根据插管方式将患者分为正中开胸插管建立体外循环组(正中开胸插管组)和外周插管建立体外循环组(外周插管组),评价两组患者的手术预后。结果共纳入80例患者,其中正中开胸插管组43例,外周插管组37例。正中开胸插管组年龄18(14,32)岁,其中男21例、女22例;外周插管组年龄16(10,27)岁,其中男18例、女19例。外周插管组转机时间201(164,230)min,显著长于正中开胸插管组143(97,188)min(P<0.001)。外周插管组停机后乳酸值显著高于正中开胸插管组[2(1,2)mmol/L vs.1(1,1)mmol/L,P=0.002]。外周插管组体外循环期间白蛋白使用量显著高于正中开胸插管组[10(0,20)g vs.0(0,0)g,P=0.004]。两组患者术后红细胞使用量无显著差异[0(0,2)U vs.0(0,0)U,P=0.117]。两组患者机械通气时间[14(11,19)h vs.13(10,15)h,P=0.296]、住ICU时间[43(23,80)h vs.40(20,67)h,P=0.237]及术后住院时间[10(7,12)d vs.8(7,10)d,P=778]差异无统计学意义。结论再次手术先天性心脏病患者经外周建立体外循环后再开胸是安全有效的方法,不影响手术预后。

Objective To evaluate the safety and efficacy of peripheral cannulation for cardiopulmonary bypass(CPB)in patients with reoperation of congenital heart disease.Methods The perioperative data of patients with congenital heart disease who underwent reoperation in Fuwai Hospital from 2019 to 2020 were retrospectively collected.They were divided into two groups according to the cannulation methods:a central group and a peripheral group.The prognosis of the patients was analyzed.Results A total of 80 patients were collected,including 43 patients in the central group,and 37 pateints in the peripheral group.In the central group,the median age was 18(14,32)years,and 21 patients were male.The median age of the peripheral group was 16(10,27)years,and 18 patients were male.The CPB time in the peripheral group was 201(164,230)min,which was longer than that in the central group[143(97,188)min,P<0.001].The lactate after CPB in the peripheral group was statistically higher than that in the central group[2(1,2)mmol/L vs.1(1,1)mmol/L,P=0.002].The dosage of albumin use during CPB in the peripheral group was statistically higher than that in the central group[10(0,20)g vs.0(0,0)g,P=0.004].There was no statistical difference in the postoperative dosage of red blood cells use[0(0,2)U vs.0(0,0)U,P=0.117],mechanical ventilation time[14(11,19)h vs.13(10,15)h,P=0.296],ICU stay time[43(23,80)h vs.40(20,67)h,P=0.237]or postoperative hospital stay time[10(7,12)d vs.8(7,10)d,P=778]between the two groups.Conclusion It’s safe and efficient to establish CPB through peripheral cannulation in patients with complex congenital heart disease undergoing reoperation.