新生儿先天性心脏病外科手术中延迟关胸的危险因素分析

Risk Factors for Delayed Sternal Closure in Operation for the Neonates with Congenital Heart Disease

目的探讨新生儿先天性心脏病(先心病)外科手术中延迟关胸的危险因素。方法回顾性分析我院2010年1月至2014年6月行手术治疗的203例新生儿先心病患儿的临床资料,其中男152例、女51例,手术年龄0~28(17.68±8.62)d。将与延迟关胸相关的因素进行单因素和多因素相关性分析。结果单因素分析结果显示,与延迟关胸有显著相关性的因素有手术时年龄、早产儿、手术时体重/手术时低体重、RACHS-1(先心病手术难度分级方法)、术前机械通气、术前静脉血管活性药物维持、体外循环时间、主动脉阻断时间、深低温停循环。多因素回归分析结果显示,与延迟关胸有显著性相关的因素有:手术时体重/手术时低体重、深低温停循环、术前机械通气。结论手术时体重/手术时低体重、深低温停循环、术前机械通气是新生儿先心病外科治疗延迟关胸的独立危险因素。

Objective To analyze the risk factors for delayed sternal closure(DSC) in the operation for the neonates with congenital heart defects.Methods We retrospectively analyzed the case notes of the 203 neonates with congenital heart defect in our hospital between January 2010 and June 2014.There were 152 males and 51 females at age of 0-28(17.68±8.62) days.The relative factors were analyzed by univariate and multivariate logistic regression.Results These factors significantly correlated with DSC in univariate analysis:age at operation,premature,low weight(weight < 2.5 kg) at operation/weight at operation,RACHS-1,mechanical ventilation before operation,continuous use of intravenous cardiovascular drugs before operation,CPB time,aortic clamping time,total circulatory arrest with profound hypothermia.The results of logistic regression analysis showed that weight at operation/low weight,pre-operative mechanical ventilation,total circulatory arrest with profound hypothermia were independent risk factors for DSC.Conclusion Weight at operation/low weight,pre-operative mechanical ventilation,and total circulatory arrest with profound hypothermia are the independent risk factors for DSC in the operation for the neonates with congenital heart defects.