介入封堵或外科修补对膜周部室间隔缺损患儿应激反应的影响及预后因素分析

The influence of interventional closure or surgical repair on stress response in children with perimembranous ventricular septal defect and their prognostic factors

目的 探讨介入封堵或外科修补对膜周部室间隔缺损(pmVSD)患儿应激反应的影响及预后因素。方法 回顾性分析2017年7月至2021年10月南京市儿童医院河西分院收治的87例pmVSD患儿的临床资料,根据资料中治疗方式的不同分为对照组(n=43)和观察组(n=44)。对照组接受外科修补术治疗,观察组接受介入封堵术治疗。比较两组手术前后心功能指标[左心室收缩末容积(LVESV)、左心室舒张末容(LVEDV)、左室射血分数(LVEF)、血管阻力(SVR)]、应激反应指标[肾上腺素(ADR)、皮质醇(Cor)、多巴胺(DA)]及术后并发症。采用多因素Logistic回归分析探讨预后相关因素。结果 对照组术后LVESV、LVEDV、SVR高于观察组,LVEF低于观察组(P<0.05)。对照组术后血清ADR、Cor、DA水平均高于观察组(P<0.05)。观察组术后并发症发生率低于对照组(13.63%vs37.21%)(χ2=6.396,P=0.011)。预后良好组的LVESV、LVEDV、SVR、LVEF、室间隔缺损直径、合并膜部瘤、手术时间、手术方式与预后不良组比较有差异(P<0.05)。多因素Logistic回归分析显示,室间隔缺损直径(OR=2.649,95%CI:1.694~4.141)、手术时间(OR=2.330,95%CI:1.553~3.496)、手术方式(OR=2.804,95%CI:1.786~4.401)是pmVSD术后患儿预后的影响因素(P<0.05)。结论 介入封堵术治疗pmVSD患儿的效果优于外科修补术,能够改善患儿的心功能,减轻应激反应,且术后并发症少。室间隔缺损直径、手术时间、手术方式是pmVSD术后患儿预后的影响因素。

Objective To explore the influence of interventional closure or surgical repair on stress response in pe-rimembranous ventricular septal defect(pmVSD)children and their prognostic factors.Methods Retrospective analysis was made on the clinical data of 87 children with pmVSD admitted to Hexi Branch of Nanjing Children’s Hospital from July 2017 to October 2021.They were divided into control group(n=43)and observation group(n=44)according to the different treat-ment methods in the data.The control group received surgical repair,and the observation group received interventional closure.Cardiac function indexes left ventricular end systolic volume(LVESV),left ventricular end diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),vascular resistance(SVR),stress response indexes[adrenaline(ADR),cortisol(Cor),dopamine(DA)]and postoperative complications were compared among two groups.The prognostic factors were explored by multivariate Logistic regression analysis.Results The LVESV,LVEDV and SVR in the control group were higher when com-pared with the observation group,and LVEF was lower when compared with the observation group(P<0.05).The levels of serum ADR,Cor and DA in the control group were higher when compared with the observation group(P<0.05).The incidence of postoperative complications in the observation group was lower when compared with the control group(13.63%vs 37.21%)(χ^(2)=6.396,P=0.011).LVESV,LVEDV,SVR,LVEF,ventricular septal defect diameter,membranous tumors,operation time,operation mode in the good prognosis group were different from those in the poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that the diameter of ventricular septal defect(OR=2.649,95%CI:1.694–4.141),operation time(OR=2.330,95%CI:1.553–3.496),and operation mode(OR=2.804,95%CI:1.786–4.401)were the influencing factors for the prognosis of children after pmVSD(P<0.05).Conclusion Interventional closure is better than surgical repair in the treat-ment of children with pmVSD.It can improve the heart function of children,reduce stress reaction,and have fewer postopera-tive complications.The diameter of ventricular septal defect,operation time and operation mode are the influencing factors for the prognosis of children after pmVSD.