先天性心脏病术后机械通气时间影响的因素分析

Analysis of factors influencing mechanical ventilation duration after surgery for congenital heart disease

目的探索先天性心脏病(先心病)患儿术后机械通气时间的影响因素。方法回顾性分析2020年10月至2023年12月在医院儿心脏中心接受手术治疗的≤6月先心病患儿的临床资料。根据机械通气时间将其分为机械通气时间延长组(≥72小时)和对照组(<72小时)。比较两组间临床特征,分析先心病术后机械通气时间延长发生的影响因素。结果纳入接受手术的先心病患儿119例,男64例、女55例,中位年龄47.0(17.0~81.0)天,营养不良(年龄别体重Z评分,WAZ)<-1的54例(45.4%),其中33例WAZ<-2。机械通气时间延长组29例、对照组90例。多因素logistic回归发现,营养不良、先心病手术风险分级(RACHS-1)评分升高是预测机械通气时间延长的独立危险因素(P<0.05),血清白蛋白升高是预测机械通气时间延长的独立保护因素(P<0.05)。所有先心病患儿经治疗后痊愈出院。结论在先心病手术患儿中,对于术前营养不良、低白蛋白血症和高RACHS-1评分的患儿,应警惕术后机械通气时间延长的发生。

Objective To explore the factors influencing the duration of mechanical ventilation after surgery in children with congenital heart disease(CHD).Methods The clinical data of children with CHD aged≤6 months who received surgical treatment at the Pediatric Heart Center of the hospital from October 2020 to December 2023 were retrospectively analyzed.Based on the duration of mechanical ventilation,the patients were divided into a prolonged mechanical ventilation group(≥72 hours)and a control group(<72 hours).Clinical characteristics between the two groups were compared,and the factors influencing the occurrence of prolonged mechanical ventilation after CHD surgery were analyzed.Results A total of 119 children(64 boys and 55 girls)with CHD who received surgery were included and the median age was 47.0(17.0-81.0)days.There were 54(45.4%)children with undernutrition(WAZ<-1).Among them,33 children had WAZ<-2.There were 29 patients in the prolonged mechanical ventilation group and 90 patients in the control group.Multivariate logistic regression analysis showed that undernutrition and increased risk adjustment for congenital heart surgery-1(RACHS-1)score were independent risk factors for predicting prolonged mechanical ventilation(P<0.05),and elevated serum albumin was an independent protective factor for predicting prolonged mechanical ventilation(P<0.05).All CHD children recovered and were discharged after treatment.Conclusions In children undergoing surgery for CHD,prolonged mechanical ventilation after surgery should be monitored in patients with preoperative malnutrition,hypoalbuminemia,and high RACHS-1 scores.