术前呼吸机通气时间对室间隔缺损患儿预后影响的回顾性队列研究

Effect of preoperative duration of mechanical ventilation on prognosis in patients with ventricular septal defect:A retrospective cohort study

目的探讨室间隔缺损患儿术前呼吸机使用时间与预后的关系。方法回顾性分析2009年5月—2020年5月在广东省人民医院手术治疗前需要呼吸机支持的室间隔缺损患儿的临床资料。依据术前呼吸机使用时间,将患儿分为三组:A组(0~47 h),B组(48~96 h)和C组(>96 h),分析每组患者术后恢复情况、术后并发症与医疗费用。结果共纳入患者272例,其中男154例、女118例,中位手术年龄为2(1,4)个月。A组43例,B组75例,C组154例。早期死亡3例(1.3%),全部为C组患者。三组死亡率差异无统计学意义(P=0.734)。三组患者术后平均呼吸机使用时间分别为(158.6±133.5)h、(101.2±56.1)h、(133.1±97.9)h,B组术后呼吸机使用时间明显短于其余两组(P<0.05)。三组患者术后住院时间分别为(17.5±9.9)d、(13.5±5.8)d、(16.5±10.8)d,B组术后住院时间明显短于其余两组(P<0.05)。三组患者平均住院期间总费用分别为(8.9±3.4)万元、(8.7±2.1)万元、(10.9±4.1)万元,C组患者费用明显高于其余两组(P≤0.001)。结论对于术前需要呼吸机支持的室间隔缺损患儿及时手术治疗是必要的,但是应该注意手术时机。相较于术前呼吸机使用时间<48 h或>96 h,术前呼吸机使用时间在48~96 h内手术疗效更佳。

Objective To summarize the relationship between preoperative duration of mechanical ventilation and prognosis in patients with ventricular septal defect.Methods The clinical data of patients with ventricular septal defect requiring ventilator support preoperatively and undergoing surgical treatment in our hospital from May 2009 to May 2020 were retrospectively reviewed.Based on the duration of preoperative ventilation,the patients were divided into three groups:a group A(0-47 hours),a group B(48-96 hours),and a group C(>96 hours).Each group's postoperative recovery,complications,and medical costs were analyzed.Results Finally 272 patients were enrolled,including 154 males and 118 females,with a median surgical age of 2(1,4)months.There were 43 patients in the group A,75 patients in the group B,and 154 patients in the group C.Early death occured in 3(1.3%)patients,all in the group C.No statistical difference in mortality was found among the three groups(P=0.734).The mean postoperative duration of mechanical ventilation in the three groups was 158.6±133.5 hours,101.2±56.1 hours,and 133.1±97.9 hours,respectively.The group B had significantly shorter duration than the other two groups(P<0.05).The mean postoperative hospital stay in the three groups was 17.5±9.9 days,13.5±5.8 days,and 16.5±10.8 days,respectively.Postoperative hospital stay in the group B was significantly shorter than that in the other two groups(P<0.05).The mean total in-hospital cost in the three groups were 89000±34000 yuan,87000±21000 yuan,and 109000±41000 yuan,respectively.The costs in the group C were significantly higher than those in the other two groups(P≤0.001).Conclusion Prompt surgical repair is necessary for patients with ventricular septal defects requiring ventilator support preoperatively.However,attention should be paid to surgical timing.Preoperative duration of mechanical ventilation is associated with better surgical outcomes within 48-96 hours than 0-47 hours or>96 hours.