儿童先天性心脏病体外循环术后合并非甲状腺疾病综合征的临床研究

Evaluations of nonthyroidal illness syndrome in children after congenital heart surgeries with cardiopulmonary bypass

目的评估先天性心脏病(congenital heart disease,CHD)患儿行体外循环心脏手术后非甲状腺疾病综合征(nonthyroidal illness syndrome,NTIS)的发生率及相关危险因素。方法收集2022年3月至2022年5月在中国医学科学院阜外医院接受体外循环心脏手术的402例CHD患儿的临床资料,其中男195例,女207例;中位年龄17(5~48)个月,中位体重10(6~15)kg。根据定义分为NTIS组(76例)和非NTIS组(326例),采用二元logistic回归评价CHD患儿NTIS的危险因素,并针对独立危险因素进行相关性分析。结果402例CHD患儿中,18.9%(76/402)的CHD患儿心脏术后发生NTIS。相较于非NTIS组,NTIS组患儿平均年龄偏小(12个月比19个月,P=0.04),且平均体重更低(8.2 kg比10.6 kg,P=0.016),NTIS组患儿平均机械通气时间显著高于非NTIS组(28.5 h比6 h,P<0.001),平均ICU时间显著高于非NTIS组(10 d比3 d,P<0.001),且不良并发症发生率更高(11%比1%,P<0.001)。多因素分析提示体外循环时间>120 min是CHD患儿心脏术后NTIS发生的独立危险因素(OR=5.36,95%CI:1.69~17.01,P=0.004),且游离三碘甲状腺素原氨酸fT3和体外循环时间呈负相关(r=-0.274,P<0.001)。结论较长的体外循环时间是CHD患儿心脏术后NTIS发生的独立危险因素,且NTIS可能是影响复杂CHD患儿体外循环术后恢复的主要因素之一。

ObjectiveTo explore the incidence and related risk factors of nonthyroidal illness syndrome(NTIS)and to explore the association between NTIS and postoperative clinical outcomes in children with congenital heart disease(CHD)after cardiac surgery.MethodsFrom March 2022 to May 2022,the relevant clinical data were retrospectively reviewed for 402 CHD children undergoing operations.There were 195 boys and 207 girls with a median age of 17(5-48)months and a median weight of 10(6-15)kg.They were assigned into two groups of NTIS(n=76)and non-NTIS(n=326).The risk factors for NTIS in children with precardiac disease were evaluated by binary Logistic regression and correlation analysis was performed for independent risk factors.ResultsAmong them,76 patients(18.9%)developed NTIS after cardiac surgery.As compared with non-NTIS group,NTIS group were more younger(12 vs 19 months,P=0.04)and had lower body weight(8.2 kg vs.10.6 kg,P=0.016).Mechanical ventilation time was significantly higher in NTIS group than that in non-NTIS group(28.5 vs 6 h,P<0.001).ICU length of stay was significantly higher than that in non-NTIS group(10 vs 3 day,P<0.001)and adverse complication rate longer(11%vs 1%,P<0.001).Multivariate analysis indicated that cardiopulmonary bypass(CPB)time>120 min is an independent risk factor for NTIS after cardiac surgery in CHD children(OR=5.36,95%CI:1.69-17.01,P=0.004).And a negative correlation exists between fT3 and CPB time(r=-0.274,P<0.001).