术前严重紫绀对法乐四联症根治术后早期恢复的影响

发布时间：2018-01-31 15:23

本文关键词： 法乐四联症紫绀心脏外科手术　出处：《中国循环杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的:探讨法乐四联症(TOF)患儿术前伴发严重紫绀与根治术后早期恢复之间的关系。方法:采用回顾性队列研究方法。选取2010-03-01至2013-03-01我院行外科根治术的TOF患儿271例作为研究对象。以术前血红蛋白浓度≥180 g/L为分组标准,将患儿分为严重紫绀组(n=48)和非严重紫绀组(n=223)。采取单因素分析法,比较两组之间的差异性。将单因素分析中具有一定差异的(P0.1)的变量纳入二元Logistic模型,用以分析变量的显著性差异。结果:单因素分析显示,与非严重紫绀组相比,严重紫绀组术后其他并发症的发生率更高(P0.001),到达负平衡时间(P=0.006)和机械通气时间更长(P=0.001);术后急性肾损伤发病率差异无统计学意义(P=0.360)。二元Logistic分析显示:严重紫绀组术后需要更长的机械通气时间(比值比:3.432,95%可信区间:1.014~5.978,P=0.015),达到负平衡的时间延长(比值比=4.823,95%可信区间:2.586~8.941,P=0.002),术后并发症发生率更高(比值比=14.322,95%可信区间:7.114~26.251,P0.001)。结论:TOF患儿术前伴发严重紫绀会显著增加术后早期各类并发症的发生率,延长机械通气时间和到达液体负平衡的时间,从而导致术后恢复延迟。
[Abstract]:Objective: to study the TOF of tetralogy of Fallot. Relationship between preoperative severe cyanosis and early recovery after radical surgery in children. Methods:. A retrospective cohort study was conducted in 271 children with TOF who underwent radical surgery from 2010-03-01 to 2013-03-01. 180. G / L is the grouping standard. The children were divided into severe cyanotic group (n = 48) and non-severe cyanotic group (n = 22 ~ (23)). Univariate analysis was used. The differences between the two groups were compared. The variables with some differences in univariate analysis were included in the binary Logistic model. Results: univariate analysis showed that the incidence of other postoperative complications in severe cyanotic group was higher than that in non-severe cyanotic group (P 0.001). Reaching negative equilibrium time (P = 0.006) and mechanical ventilation time (P = 0.001); There was no significant difference in the incidence of acute renal injury after operation. Binary Logistic analysis showed that the severe cyanosis group needed longer mechanical ventilation time after operation (. The ratio is: 3.432. The 95% confidence interval was 1.014 / 5.978 and the time to reach the negative equilibrium was prolonged (ratio of 4.823 / 95% CI: 2.586 / 8.941). The incidence of postoperative complications was higher than 14.322 95% CI: 7.114% 26.251. Conclusion severe cyanosis before operation can significantly increase the incidence of early postoperative complications, prolong the time of mechanical ventilation and the time to reach the negative balance of fluid in children with TOF. As a result, postoperative recovery is delayed.
【作者单位】：北京协和医学院中国医学科学院国家心血管病中心阜外医院小儿外科中心;北京协和医学院中国医学科学院国家心血管病中心阜外医院小儿重症监护室;
【分类号】：R726.5
【正文快照】： 受中国各地区经济水平和医疗救治水平差异的术后48 h内选取最高血肌酐用于和术前血肌酐影响,我国先天性心脏病(先心病)患儿接受手术治进行比较。正性肌力药物评分[7(]VIS)={多巴胺[μg/疗时间相对较晚[1]。对于紫绀型先心病患儿,较晚(kg·min)]+多巴酚丁胺[μg/(kg·min)]+100

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