摘要
目的观察高原地区和平原地区先天性心脏病患儿在平原地区手术的基线资料和围术期并发症,探讨围术期并发症的差异。方法回顾性分析2014年1月至2023年12月在南京医科大学第二附属医院诊疗的先天性心脏病患儿的临床资料,根据海拔高度分为高原组和平原组,根据手术方式分为外科组和介入组,分析高原组和平原组基线资料及围术期并发症差异,进一步分析外科手术和介入手术的患儿中高原组和平原组之间的差异。结果经过纳入排除后,共收集1388例先天性心脏病患儿,年龄0~18岁,平均年龄在77.0(39.50~140.50)个月,其中房间隔缺损(ASD)580(41.8%)例,室间隔缺损(VSD)437例(31.5%),动脉导管未闭(PDA)244例(17.6%),法洛四联症(TOF)50例(3.6%)。定义居住在海拔超过2500 m地区的患儿为高原组,居住在海拔低于500 m地区的患儿为平原组,高原组395例,平原组993例。高原组以ASD(47.3%)和PDA(25.8%)为主,平原组以ASD(39.6%)和VSD(35.8%)为主。高原组患儿术前肺炎发生率高于平原组患儿(P<0.01);高原组往往在ICU停留的时间比平原组长(P<0.05);术前两组之间N末端B型利钠肽原(NT-proBNP)水平有统计学差异(P<0.05),术后新发窦性心动过缓两组间有统计学差异(P<0.05),经过外科治疗的患者出院时射血分数(EF)值低于60%,两组之间存在差异(P<0.05)。结论高原组先天性心脏病以ASD和PDA为主,平原组先天性心脏病以ASD和VSD为主。高原地区先天性心脏病患儿与平原地区患儿的基线资料和围术期并发症有所不同,针对不同海拔地区的先天性心脏病患儿需要更加个体化的治疗方案。
Objective To observe the baseline data and perioperative complications of children with congenital heart disease operated in plain area and plateau area,and to explore the difference of perioperative complications.Method The clinical data of children with congenital heart disease treated in the Second Affiliated Hospital of Nanjing Medical University from January 2014 to December 2023 were retrospectively analyzed.According to the altitude,they were divided into plateau group and plain group,and according to the operation method,they were divided into surgical group and intervention group.The differences between the plateau group and the plain group in the children who underwent surgical operation and interventional surgery were further analyzed.Results After the exclusion,a total of 1388 children with congenital heart disease were enrolled,aged 0-18 years,with an average age of 77.0(39.50,140.50)months.There were 580(41.8%)atrial septal defect(ASD)cases and 437(31.5%)ventricular septal defect(VSD)cases.There were 244 cases(17.6%)of patent ductus arteriosus(PDA)and 50 cases(3.6%)of tetralogy of Fallot(TOF).Children living in an altitude of more than 2500 m were defined as the plateau group,and those living in an altitude of less than 500 m were defined as the plain group.ASD(47.3%)and PDA(25.8%)were the main types in the plateau group,and ASD(39.6%)and VSD(35.8%)were the main types in the plain group.The plateau group had a significantly higher incidence rate of preoperative pneumonia than the plain group(P<0.01).The plateau group tended to stay in ICU longer than the plain group(P<0.05).There were significant differences in N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels between the two groups before surgery(P<0.05).There were significant differences in new onset sinus bradycardia after surgery between the two groups(P<0.05).The ejection fraction(EF)value was less than 60%in patients who underwent surgical treatment at discharge,and there was a difference between the two groups(P<0.05).Conclusion ASD and PDA were the main congenital heart diseases in the plateau group,and ASD and VSD were the main congenital heart diseases in the plain group.There are some differences in baseline data and perioperative complications between children with congenital heart disease at high altitude and those at plain areas.Therefore,more individualized treatment strategies are needed for children with congenital heart disease at different altitudes.
作者
刘轩滔
张冲
邵峻
杨志豪
耿直
苏东明
李庆国
LIU Xuan-tao;ZHANG Chong;SHAO Jun;YANG Zhi-hao;GENG Zhi;SU Dong-ming;LI Qing-guo(Department of Cardiovascular Surgery,Second Affiliated Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Pathology,Nanjing Medical University,Nanjing 211166,China)
出处
《中国心血管病研究》
CAS
2024年第11期1001-1006,共6页
Chinese Journal of Cardiovascular Research
基金
国家自然科学基金(82170503)
江苏省重点研发计划(BE2021749)。
关键词
先天性心脏病
并发症
高原地区
围手术期
Congenital heart disease
Complications
High altitude areas
Perioperative period