CAJ | 학술논문

目的总结小儿心脏术后早期(<72 h)合并呼吸道合胞病毒(Respiratory Sncytial Virus,Rsv)感染对患儿术后病程的影响及其转归并分析总结治疗经验.方法回顾分析2005年5月至2008年5月浙江大学医学院附属儿童医院SICU收治的39名先天性心脏病(先心病)心内直视术后早期合并RSV感染的患儿的术后病程和转归.并1:1随机配对抽取同期收治的同年龄、同病种、无RSV感染的先心病心内直视后的39名患儿作为对照组.采取成组配对设计资料的t检验法比较两组患儿的呼吸机辅助通气时间、住ICU时间和住院时间;采取Fisher精确检验法检验二次插管率、无创辅助通气应用率以及术后常见并发症的发生率.再根据患儿年龄、先心病病种以及是否合并肺动脉高压进行分组比较.结果两组患儿均痊愈出院.RSV感染显著延长患儿的呼吸机辅助通气时间、住ICU时间和住院时间,并增加术后肺不张的发生率(P<0.05).对年龄<6个月的患儿RSV感染不仅显著延长呼吸机辅助通气时间、住ICU时间和住院时间(P<0.05),还增加术后低心排综合征和合并感染的发生率(P=0.05);而对>24月的患儿无显著影响.对紫绀型先心病患儿显著延长其呼吸机辅助通气时间,住ICU时间和住院时间(P<0.05);对非紫绀型先心病患儿仅显著延长住ICU时间和住院时间(P均<0.05).对合并肺动脉高压患儿RSV感染不仅显著延长呼吸机辅助通气时间,住ICU时间和住院时间,还增加术后合并感染的发生率(P均<0.05);而对无肺动脉高压患儿仅延长住院时间(P<0.05).结论小儿心脏手术后早期合并RSV感染会对术后病程产生不良影响,尤其对小婴儿,紫绀型先心及合并肺动脉高压的患儿影响更大.早期诊断,采取有效的循环、呼吸支持结合抗病毒等综合治疗取得了较满意的治疗效果.
목적 총결소인심장술후조기(<72 h)합병호흡도합포병독(Respiratory Sncytial Virus,Rsv)감염대환인술후병정적영향급기전귀병분석총결치료경험.방법회고분석2005년5월지2008년5월절강대학의학원부속인동의원SICU수치적39명선천성심장병(선심병)심내직시술후조기합병RSV감염적환인적술후병정화전귀.병1:1수궤배대추취동기수치적동년령、동병충、무RSV감염적선심병심내직시후적39명환인작위대조조.채취성조배대설계자료적t검험법비교량조환인적호흡궤보조통기시간、주ICU시간화주원시간;채취Fisher정학검험법검험이차삽관솔、무창보조통기응용솔이급술후상견병발증적발생솔.재근거환인년령、선심병병충이급시부합병폐동맥고압진행분조비교.결과 량조환인균전유출원.RSV감염현저연장환인적호흡궤보조통기시간、주ICU시간화주원시간,병증가술후폐불장적발생솔(P<0.05).대년령<6개월적환인RSV감염불부현저연장호흡궤보조통기시간、주ICU시간화주원시간(P<0.05),환증가술후저심배종합정화합병감염적발생솔(P=0.05);이대>24월적환인무현저영향.대자감형선심병환인현저연장기호흡궤보조통기시간,주ICU시간화주원시간(P<0.05);대비자감형선심병환인부현저연장주ICU시간화주원시간(P균<0.05).대합병폐동맥고압환인RSV감염불부현저연장호흡궤보조통기시간,주ICU시간화주원시간,환증가술후합병감염적발생솔(P균<0.05);이대무폐동맥고압환인부연장주원시간(P<0.05).결론소인심장수술후조기합병RSV감염회대술후병정산생불량영향,우기대소영인,자감형선심급합병폐동맥고압적환인영향경대.조기진단,채취유효적순배、호흡지지결합항병독등종합치료취득료교만의적치료효과.
Objective To summzarize the impacts of respiratory syncytial virus (RSV) infection in the early period(< 72 h) on the postoperative course after open-heart surgery in pediatric patients, and to discuss the expe-riences on therapeutic strategies. Method From March 2005 to March 2008, 39 patients diagnosed to be RSV in-fection confmned by RSV antigen test were prospectively enrolled into RSV-infeetion group. Anoth.er 39 patients were randomly 1 : 1 matched with age and same type of congenital heart disease (CHD) during the same period who also underwent open-heart surgery without RSV infection (nonRSV-infection group) as control group. The medical records of these patients were retrospectivdy reviewed. The duration of mechanical ventilation (MV), length of ICU stay and hospital stay were compared between the two groups with Paired Student's t test. Meanwhile Fisher' s exact test was used to compare the differences in noninvasive positive pressure ventilation, incidence rate of re-intubafion and severe postoperative complications between groups. Patients in both groups were further divided into subgroups aceonting to differences in age, cyanosis and pulmonary arterial pressure in order to identify the dif-ferent impacts of RSV infection in patients in different settings. Results All the patients were survived and dis-charged home. RSV infection significantly prolonged the duration of MV, ICU and hospital stay (all P < 0. 05).In addition, it significantly increased the incidence of pulmonary atelectasis (P < 0.05). In patients under 6 months old, RSV infection resulted in prolongation of MV, ICU and hospital stay (all P <0.05); furthermore, it significantly increased the incidence of complications of low cardiac output syndrome and bacteria co-infection (both P = 0.05). In patients over 24 months, RSV infection had no significant impacts in all the parameters which are compared between the two groups. In patients with cyanotic CHD, RSV infection significantly prolonged the duration of MV, ICU stay and hospital stay (all P < 0.05). In patients with cyanotic CHD, RSV infection significantly prolonged the duration of ICU stay and hospital stay (P <0.05). In patients with pulmonary hyper-tension, RSV infection significantly prolonged the duration of MV, ICU and hospital stay(all P <0.05), and in-creased the incidence rate of concomitant infection (P < 0.05). However, in patients without pulmonary hyper-tension, RSV infection only significantly increased the length of hospital stay (P < 0.05). Conclusions RSV in-fection in the early period after open-heart surgery in pediatric patients has significant adverse impacts on the post-operative course, especially in those patients under 6 months old, patients with pumonary hypertension or cyanotic CHD. Early diagnosis, and effective circulatory and respiratory support,alone with antivirus results in a satisfied outcome.