右室肺动脉外管道置换术后延迟恢复影响因素研究

Influence factors of delayed recovery after right ventricular-extrapulmonary arterial conduit reconstruction

目的探索右室肺动脉外管道置换术后早期延迟恢复的危险因素。方法回顾性分析2017至2021年我院收治的行右室肺动脉外管道置换术患儿,根据患儿ICU滞留时间分为正常恢复组和延迟恢复组。收集患儿基础资料以及围术期相关临床资料,进行统计学分析。结果共入组55例患儿,将所有患儿术后ICU滞留时间按照从短到长进行排序,排在第75%位点的ICU滞留时间(7 d)定义为分组界值,正常恢复组(ICU滞留时间≤7 d)40例,延迟恢复组(ICU滞留时间>7 d)15例。全组患儿呼吸机使用时间24(0,1 408)h,ICU住院时间4(1,67)d。体外膜肺氧合(ECMO)辅助6例,死亡2例。两组患儿多因素Logistic回归分析显示,体外循环时间长(OR=1.034,95%CI 1.009~1.061,P=0.009)、右心功能差(OR=9.536,95%CI 1.010~90.037,P=0.049)为延迟恢复的危险因素。结论右室肺动脉外管道置换术后风险高,ECMO辅助比例及病死率高。右心功能不全、体外循环时间长是术后延迟恢复的危险因素。

Objective To explore the risk factors of early delayed recovery after right ventricular-extrapulmonary arterial(RV-PA)conduit reconstruction.Methods From 2017 to 2021,the children with RV-PA conduit reconstruction,who were treated in our hospital were retrospectively analyzed.The demographic data and peri-operative clinical data of the patients were collected for statistical analysis.Results Fifty-five patients were included in the study.The patients were sequenced by the length of ICU stay.The time at the 75th percentile was defined as the critical value for grouping.According to the ICU stay time of the children,they were divided into normal recovery group(ICU stay≤7 days,n=40)and delayed recovery group(ICU stay>7 days,n=15).The mechanical ventilator time in the whole group was 24(0,1408)h,and the ICU stay time was 4(1,67)d.Six cases required extracorporeal membrane oxygenation(ECMO)support,and two cases died.In the multivariate Logistic regression analysis of two groups,long cardiopulmonary bypass(CPB)time(OR=1.034,95%CI 1.009-1.061,P=0.009)and poor right ventricular function(OR=9.536,95%CI 1.010-90.037,P=0.049)were independent risk factors for early delayed recovery.Conclusion The risk of RV-PA conduit reconstruction is high.The proportion of ECMO support is increased.The mortality rate is higher.Right heart dysfunction and prolonged CPB time are risk factors for delayed postoperative recovery.