先天性心脏病术后心包积液的临床特点及危险因素分析

发布时间：2018-01-17 12:46

本文关键词：先天性心脏病术后心包积液的临床特点及危险因素分析　出处：《浙江大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨小儿先心术后心包积液的发生率、临床表现、治疗方法,并分析其危险因素。方法：回顾分析2012年1月至12月在浙江大学医学院附属儿童医院心胸外科接受体外循环手术治疗的658例先天性心脏病患儿临床资料,根据术后心超是否发现心包积液将患儿分为心包积液组及非心包积液组,观察并比较心包积液组患儿与非心包积液组患儿的临床资料,分析先心术后心包积液的危险因素。结果：共651例患儿纳入研究,其中45例(6.9%)术后出现心包积液。少量心包积液32例(71.1%)、中等量心包积液10例(22.2%)、大量心包积液3例(6.7%)。心包积液平均出现于术后9.7±5.7天(4-32天,中位数8天)。45例心包积液组患儿中,仅12例(26.7%)有临床表现,其中多数呈非特异性表现,仅1例(2.2%)有心包填塞表现。与少量心包积液患者相比,中、大量心包积液患者临床症状和体征的出现率相对较高(9.3%vs69.2%,p0.001)。43例(93.3%)初始保守治疗,42例经保守治疗后痊愈,1例保守治疗无效,经皮心包穿刺后痊愈。另2例大量心包积液均经B超引导下经皮心包穿刺引流后痊愈。心包积液组患儿术后住院时间显著延长(16.6±±7.9天vs.13.1±7.6天,p=0.005),但两组间总住院时间并无显著差异(p0.05)。单因素分析发现,体外循环时间及主动脉夹闭时间延长,心包积液风险增加(p0.05)。6岁以上患儿心包积液发生率显著高于6岁以下患儿(12.7%vs.6.1%,p=0.032,OR=2.22,95%置信区间：1.5～4.7)。完全性肺静脉异位引流及Ebstein畸形矫治术后心包积液的发生率显著高于左向右分流型矫治手术(30.0%vs6.1%,p=0.009；50.0%vs.6.1%,p=0.007)。Logistic多因素回归发现,体外循环时间延长、TAPVC及Ebstein畸形手术是术后心包积液发生的独立危险因素。结论：小儿先心术后心包积液在临床并不少见,其临床表现多呈非特异性,部分可无任何症状或体征。先心术后心包积液可经保守治疗得到改善,对于部分出现血流动力学变化的大量心包积液及心包填塞患儿需进一步行有创治疗。CPB时间延长、TAPVC及Ebstein畸形矫治术是术后出现心包积液的独立危险因素。
[Abstract]:Objective: to investigate the incidence, clinical manifestation, treatment and risk factors of pericardial effusion after cardiac surgery in children. Methods: the clinical data of 658 children with congenital heart disease received cardiopulmonary bypass surgery from January 2012 to December in the Children's Hospital affiliated to Zhejiang University Medical College were retrospectively analyzed. Children with pericardial effusion were divided into pericardial effusion group and non-pericardial effusion group according to whether or not pericardial effusion was found after operation. The clinical data of pericardial effusion group and non-pericardial effusion group were observed and compared. To analyze the risk factors of pericardial effusion after cardiac surgery. Results: a total of 651 children were included in the study, of whom 45 had pericardial effusion and 32 had small pericardial effusion. There were 10 cases with moderate pericardial effusion and 3 cases with massive pericardial effusion. The mean occurrence of pericardial effusion was 9.7 卤5.7 days and 4-32 days after operation. Of the 45 patients with pericardial effusion on the median of 8 days, only 12 patients with pericardial effusion had clinical manifestations, most of which were nonspecific. Compared with the patients with a small amount of pericardial effusion, the incidence of clinical symptoms and signs in patients with large amounts of pericardial effusion was higher than that in patients with moderate pericardial effusion (9.3vs 69.2%). The initial conservative treatment of 42 cases was cured after conservative treatment and 1 case had no effect of conservative treatment. 2 cases of pericardial effusion were cured by percutaneous pericardial drainage under the guidance of B-ultrasound. The postoperative hospitalization time of children with pericardial effusion group was significantly prolonged (P < 0.05). 16.6 卤7.9days vs.13.1 卤7.6days. There was no significant difference in total hospital stay between the two groups (p 0.05). Univariate analysis showed that the time of CPB and aortic clamping was prolonged. The incidence of pericardial effusion in children over the age of 0. 05 years was significantly higher than that in children under 6 years of age. The incidence of pericardial effusion was significantly higher in children under 6 years of age than in children under 6 years of age. The incidence of pericardial effusion after complete anomalous pulmonary venous drainage and Ebstein malformation was significantly higher than that of left to right shunt surgery. 30.0% vs 6.1%. P0. 009; Logistic regression showed that the time of CPB was prolonged. TAPVC and Ebstein are independent risk factors for postoperative pericardial effusion. Conclusion: pericardial effusion is not uncommon in children after cardiac surgery, its clinical manifestations are nonspecific, and some of them have no symptoms or signs. Pericardial effusion can be improved by conservative treatment. For partial hemodynamic changes of a large number of pericardial effusion and pericardial tamponade children need further invasive treatment. CPB time prolongation. TAPVC and Ebstein were independent risk factors for pericardial effusion.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R726.1

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