CAJ | 학술논문

目的本文回顾性分析影响低出生体重(＜2.5kg)食管闭锁患儿预后的因素,旨在指导临床判断.方法对1999年1月至2008年12月收治入本院的食管闭锁患儿回顾性分析:①生存率与出生体重相关性;②低出生体重儿术前急性事件(难以控制高热、呼吸衰竭、血流动力学等)和术中急性事件(插管困难、通气困难、血氧饱和度＜90%等)发生率;③出生体重与术后并发症、术后机械通气时间及生存率的关系;④术后应激性高血糖与生存率及术后并发症的相关性;⑤Logistic回归模型分析低出生体重、心脏畸形、术后高血糖对生存率的影响.结果 101例食管闭锁患儿中,出生体重＜2 500 g的患儿29例.总生存率87.2%,低出生体重儿生存率较低(75.9%vs 92.3%,P=0.027),体重越轻,生存率越低,二者正相关(r=0.946,P=0.015).术前急性事件和术中急性事件发生率明显高于正常出生体重儿(67.7%vs 32.9%,P=0.002;70%vs 26%,P=0.001).吻合口瘘和狭窄发生率高,术后机械通气时间延长(P=0.001).术后应激性高血糖者总体生存率低(93.6%vs81.0%,P=0.024),高血糖与生存率呈负相关(r=-0.931,P=0.022),Logistic回归分析资料表明应激性高血糖对食管闭锁预后有独立的影响作用.结论低出生体重是影响食管闭锁生存率的主要因素,体重越轻,生存率越低;术中、术后并发症较高;术后应激性高血糖是影响生存率的重要因素之一.
목적 본문회고성분석영향저출생체중(＜2.5kg)식관폐쇄환인예후적인소,지재지도림상판단.방법 대1999년1월지2008년12월수치입본원적식관폐쇄환인회고성분석:①생존솔여출생체중상관성;②저출생체중인술전급성사건(난이공제고열、호흡쇠갈、혈류동역학등)화술중급성사건(삽관곤난、통기곤난、혈양포화도＜90%등)발생솔;③출생체중여술후병발증、술후궤계통기시간급생존솔적관계;④술후응격성고혈당여생존솔급술후병발증적상관성;⑤Logistic회귀모형분석저출생체중、심장기형、술후고혈당대생존솔적영향.결과 101례식관폐쇄환인중,출생체중＜2 500 g적환인29례.총생존솔87.2%,저출생체중인생존솔교저(75.9%vs 92.3%,P=0.027),체중월경,생존솔월저,이자정상관(r=0.946,P=0.015).술전급성사건화술중급성사건발생솔명현고우정상출생체중인(67.7%vs 32.9%,P=0.002;70%vs 26%,P=0.001).문합구루화협착발생솔고,술후궤계통기시간연장(P=0.001).술후응격성고혈당자총체생존솔저(93.6%vs81.0%,P=0.024),고혈당여생존솔정부상관(r=-0.931,P=0.022),Logistic회귀분석자료표명응격성고혈당대식관폐쇄예후유독립적영향작용.결론 저출생체중시영향식관폐쇄생존솔적주요인소,체중월경,생존솔월저;술중、술후병발증교고;술후응격성고혈당시영향생존솔적중요인소지일.
Objective To investigate the prognostic factors of survival rate after repair of esophageal atresia (EA) and/or tracheoesophageal fistula (TEF). Methods The clinical data of the 101 patients underwent TEF/EA repair between January 1999 and December 2008 at this center were retrospectively reviewed. The patients were divided into low-birth-weight group (29 patients, birth-weight＜2 500 grams) and normal-birth-weight group (72 patients, birth-weight＞2. 5 kg). The possible prognostic factors were retrospectively analyzed including patients status, the incidence of preoperative and intraoperative critical events, postoperative complications, postoperative mechanical ventilation time,stress hyperglycemia and survival rate. Logistic regression analysis was employed to predict the prognostic factors of the survival rate after repair of EA and/or TEF. Results Of the 29 low-birth-weight EA patients, the survival rate was significantly lower than that of the normal birth weight patients (75.9% vs 92. 3% ,P = 0. 027) ,and the survival rate positively correlated with the birth weight (r=0. 946,P= 0. 015). The incidence of preoperative and intraoperative critical events and postoperative complications in low-birth-weight EA patients were significantly higher than those of the normal birth weight patients (67. 7% vs 32. 9% ,P = 0. 002; 70% vs 26%, P = 0. 001 ). The morbidity of anastomotic stricture and leak was higher, and postoperative mechanical ventilation time was longer compared with the normal birth weight patients (P = 0. 001 ). The survival rate of the patients had postoperative stress hyperglycemia was lower than that of patients without stress hyperglycemia (93. 6% vs 81.0%,P = 0. 024) ,and the survival rate negatively correlated with the severity of postoperative stress hyperglycemia (r = - 0. 931, P = 0. 022). Conclusions Low-birth-weight and postoperative stress hyperglycemia are the prognostic factors of survival rate after repair of EA and/or TEF.