先天性心脏病术后婴儿血管活性药物评分与其预后的相关性研究

发布时间：2018-07-28 17:32

【摘要】：目的:对体外循环下先天性心脏病术后围术期婴儿所用的血管活性药物进行评分,探讨其对患者预后结局的影响。方法:回顾性收集53例体外循环下行先天性心脏病手术的6月龄以下婴儿的临床资料,并对术后第1个24 h、第2个24 h血管活性药物评分(vasoactive-inotropic score,VIS)进行统计均值(mean,MEA)和最大值(maximum,MAX)[VIS(24MAX)、VIS(24MEA)、VIS(48MAX)、VIS(48MEA)],采用ROC曲线、t检验及卡方检验对血管活性药物评分和预后结局的相关性进行分析。结果:53例患儿中新生儿6例(6/53,11.32%);除房间隔缺损(atrial septal defect,ASD)、室间隔缺损(ventricular septal defect,VSD)之外复杂性先天性心脏病患儿11例(11/53,20.75%),包括完全性房室间隔缺损(complete atrioventricular septal defect,CAVC)1例、右室双出口(double outlet of right ventricle,DORV)1例、大动脉转位(translocation of great arteries,TGA)6例、肺动脉瓣闭锁(pulmonary valve atresia,PVA)1例、完全性肺静脉异位连接(total anomalous pulmonary venous connection,TAPVC)2例;死亡3例(3/53,5.66%);3种严重病情结局中缺氧缺血性脑损伤5例(5/53,9.43%),心肺复苏5例(5/53,9.43%),血液净化4例(4/53,7.56%);ROC曲线统计显示VIS(24MAX)分别对本组患儿严重病情结局和死亡的预后判断更准确(AUROC=0.938,P=0.000;AUROC=0.943,P=0.010),并计算出VIS(24MAX)对严重病情结局和死亡预测的最佳临界值均为19.5分(J=0.798,J=0.82);同时VIS(24MAXh)组[VIS(24MAX)≥19.5分]患儿的死亡率、严重病情结局比率及乳酸值均明显高于VIS(24MAXl)组[VIS(24MAX)19.5分]患儿(25%0%,χ2=6.688,P=0.01;66.67%2.44%,χ2=22.799,P=0.000;5.681.67,t=3.329,P=0.006)且非死亡患儿中VIS(24MAXh)组患儿的机械通气时间和住重症监护室(intensive care unit,ICU)时间均显著高于VIS(24MAXl)组患儿(133.8938.56,t=4.207,P=0.002;7.673.27,t=4.247,P=0.002)。结论:先天性心脏病术后小婴儿血管活性药物评分,尤其是术后第1个24 h内最大血管活性药物评分,对疾病严重程度及预后有较好的预判作用;其值越大,病情越严重,预后越差,死亡率越高。
[Abstract]:Objective: To evaluate the effects of the vasoactive drugs on the prognosis of the perioperative infants with congenital heart disease after cardiopulmonary bypass. Methods: retrospective collection of 53 cases of congenital heart disease under extracorporeal circulation of 6 month old infants under the clinical materials, and first 24 h after operation, second 24 h vasoactivity Vasoactive-inotropic score (VIS) was used to perform statistical mean (mean, MEA) and maximum value (maximum, MAX) [VIS (24MAX), VIS (24MEA) and VIS (VIS)). The correlation between the score of vasoactive drugs and the outcome of the prognosis was analyzed by means of curve, test and Chi square test. Results: 6 neonates in 53 cases; 11 cases of complicated congenital heart disease (11/53,20.75%) in children with atrial septal defect (ASD) and ventricular septal defect (ventricular septal defect, VSD), including 1 cases of complete atrioventricular septal defect (complete atrioventricular septal), 1 cases of right ventricular double exit 6 cases of translocation of great arteries (TGA), 1 cases of pulmonary artery valve atresia (pulmonary valve atresia, PVA), 2 cases of total anomalous pulmonary vein ectopic connection (total anomalous pulmonary), 3 cases of death, 5 cases of hypoxic-ischemic brain injury in 3 serious illness outcomes, and 5 cases of cardiopulmonary resuscitation (5 cases) 43%), 4 cases of blood purification (4/53,7.56%); ROC curve statistics showed that VIS (24MAX) was more accurate for the prognosis of severe illness and death (AUROC=0.938, P=0.000; AUROC=0.943, P=0.010) in this group, respectively, and calculated that the optimal critical value of VIS (24MAX) for severe illness outcome and death was 19.5 (J=0.798, J=0.82). Xh) the mortality of children with [VIS (24MAX) > 19.5) was significantly higher than that of VIS (24MAXl) group [VIS (24MAX) 19.5] (25%0%, P=0.01, 66.67%2.44%, Chi, P=0.01; 66.67%2.44%, P=0.01; The time of intensive care unit (ICU) was significantly higher than that of children in VIS (24MAXl) group (133.8938.56, t=4.207, P=0.002; 7.673.27, t=4.247, P=0.002). Conclusion: the vasoactive drug score of the infant with congenital heart disease, especially the first 24 maximal blood tube active drug scores after the operation, has a better prognosis for the severity and prognosis of the disease. The greater the value, the more serious the disease is. The worse the prognosis, the higher the mortality.
【作者单位】：重庆医科大学附属儿童医院重症医学科儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室;
【基金】：重庆市科委基础与前沿研究计划资助项目(编号:cstc2013jcyj A10031)
【分类号】：R726.5

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