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目的分析影响先天性心脏病婴儿行心脏手术后近期预后的危险因素,以采用适当的治疗措施加以干预,改善患者的预后。方法回顾性分析2009年11~12月期间北京阜外心血管病医院98例在体外循环(CPB)下行先天性心脏病矫治术婴儿患者的临床资料,依据术后是否发生并发症将98例患者分为两组,无并发症组(n=40):男24例,女16例,年龄7.60±0.40个月,体重7.80±0.30 kg;有并发症组(n=58):男42例,女16例,年龄6.20±0.40个月,体重6.70±0.20 kg。记录两组患者的围术期临床指标,包括术前空腹血糖、肌酐、术中主动脉阻断时间、改良超滤或零平衡超滤、术后血糖水平、乳酸浓度、血管活性药物应用和并发症的发生情况等。根据先天性心脏病手术风险校正评分(RACHS-1)对患者进行手术风险分级。采用单因素和logistic多因素回归分析影响婴儿手术后近期预后的危险因素。结果围术期因循环衰竭死亡1例(1.02%)。需2种正性肌力药物支持>48 h 37例次,机械通气时间>24 h 29例次,需二次气管内插管5例次,气管切开1例次,发生院内感染31例次,切口感染4例次,肾功能衰竭3例次,肝功能异常1例次。logistic回归分析结果显示:年龄(OR=0.750,P=0.012)、脉搏血氧饱和度(OR=0.840,P=0.005)、主动脉阻断时间(OR=1.040,P=0.008)和术后血糖水平(平均血糖水平<8.33 mmol/L的患者术后发生不良事件的概率升高约5倍;OR=5.051,P=0.011)是影响行先天性心脏病矫治术婴儿近期预后的危险因子。结论年龄、术前脉搏血氧饱和度和主动脉阻断时间与行先天性心脏病矫治术婴儿患者术后近期不良预后有关。现有证据尚不足以证实围术期高血糖是不良预后的危险因子。
Objective To analyze the risk factors affecting the short-term prognosis of cardiac surgery in infants with congenital heart disease and to improve the prognosis of the patients by appropriate treatment measures. Methods The clinical data of 98 infants with congenital heart disease undergoing Cardiopulmonary Bypass (CPB) from Dec 2009 to Dec 2009 in Beijing Fuwai Hospital were retrospectively analyzed. According to the postoperative complications, 98 patients There were 24 males and 16 females, with a mean age of 7.60 ± 0.40 months and a body weight of 7.80 ± 0.30 kg. Complications (n = 58) 16 females, aged 6.20 ± 0.40 months, body weight 6.70 ± 0.20 kg. The perioperative clinical parameters, including preoperative fasting blood glucose, creatinine, intraoperative aortic blockade time, modified or zero balance ultrafiltration, postoperative blood glucose level, lactate concentration, vasoactive drug application and concurrent Occurrence of disease and so on. Patients were scored for surgical risk based on the Surgical Risk Correction Scoring for Congenital Heart Disease (RACHS-1). Univariate and logistic multivariate regression analysis was used to analyze the risk factors that influence the short-term prognosis of infants after surgery. Results Perioperative death due to circulatory failure in 1 case (1.02%). Requiring 2 kinds of inotropic muscular support> 48 h for 37 cases and mechanical ventilation> 24 h for 29 cases, requiring 5 times of secondary endotracheal intubation, 1 case of tracheotomy and 31 cases of nosocomial infection , Incision infection in 4 cases, renal failure in 3 cases, abnormal liver function in 1 case. Logistic regression analysis showed that the age (OR = 0.750, P = 0.012), pulse oximetry (OR = 0.840, P = 0.005), aortic cross-clamping time The average risk of adverse events in patients with congenital heart disease was about 5-fold (OR = 5.051, P = 0.011). Conclusions Age, preoperative pulse oximetry and aortic cross-clamping time are related to the recent poor prognosis of infant patients undergoing congenital heart disease. The available evidence is not sufficient to confirm the perioperative hyperglycemia is a risk factor for poor prognosis.