中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2012年
5期
484-487
,共4页
周智恩%严善秀%何伦德%王道庄%李正国%邓硕曾
週智恩%嚴善秀%何倫德%王道莊%李正國%鄧碩曾
주지은%엄선수%하륜덕%왕도장%리정국%산석증
法洛四联症%法洛四联症根治术%危险因素%病死率%儿童
法洛四聯癥%法洛四聯癥根治術%危險因素%病死率%兒童
법락사련증%법락사련증근치술%위험인소%병사솔%인동
Tetralogy of Fallot%Total correction of tetralogy of Fallot%Risk factors%Mortality%Children
目的 探讨小儿法洛四联症(tetralogy of Fallot,TOF)手术后早期死亡的危险因素,以提高手术成功率,降低手术病死率.方法 2003年1 月至2010年12月期间在成都心血管病医院行TOF根治术患儿191例,其中男142例,女49例;年龄4个月～12岁.收集所有患儿术前、术中和术后的临床资料,分析影响TOF手术后早期死亡的危险因素.结果 191例患儿,围术期死亡6例(3.14％),死于手术后感染合并多器官功能衰竭3例,低心排血量综合征2例,脑部并发症1例.其中≤6个月患儿病死率6.67％(2/30),6个月～3岁患儿病死率1.41％ (1/71),3～12岁患儿病死率3.33％ (3/90).多因素Logistic回归分析结果表明,年龄≤6个月(OR=4.606,95％CI 1.811 ～11.719,P＜0.05)、术前血氧饱和度＜70％(OR=0.982,95％ CI 0.501 ～ 1.932,P＜0.01)、Nakata指数＜140mm2/m2(OR=16.960,95％CI 1.414 ～ 150.390,P＜0.01)、体外循环时间＞150 min(OR=4.398,95％CI2.091 ～9.216,P＜0.01)及术后多器官功能衰竭(OR=4.872,95％CI 2.583 ～ 9.192,P＜0.05)是小儿TOF根治术后早期死亡的危险因素.结论 临床上可根据患儿年龄、术前血氧饱和度、Nakata指数、体外循环时间及术后并发症预测TOF根治术后早期死亡的危险性.
目的 探討小兒法洛四聯癥(tetralogy of Fallot,TOF)手術後早期死亡的危險因素,以提高手術成功率,降低手術病死率.方法 2003年1 月至2010年12月期間在成都心血管病醫院行TOF根治術患兒191例,其中男142例,女49例;年齡4箇月～12歲.收集所有患兒術前、術中和術後的臨床資料,分析影響TOF手術後早期死亡的危險因素.結果 191例患兒,圍術期死亡6例(3.14％),死于手術後感染閤併多器官功能衰竭3例,低心排血量綜閤徵2例,腦部併髮癥1例.其中≤6箇月患兒病死率6.67％(2/30),6箇月～3歲患兒病死率1.41％ (1/71),3～12歲患兒病死率3.33％ (3/90).多因素Logistic迴歸分析結果錶明,年齡≤6箇月(OR=4.606,95％CI 1.811 ～11.719,P＜0.05)、術前血氧飽和度＜70％(OR=0.982,95％ CI 0.501 ～ 1.932,P＜0.01)、Nakata指數＜140mm2/m2(OR=16.960,95％CI 1.414 ～ 150.390,P＜0.01)、體外循環時間＞150 min(OR=4.398,95％CI2.091 ～9.216,P＜0.01)及術後多器官功能衰竭(OR=4.872,95％CI 2.583 ～ 9.192,P＜0.05)是小兒TOF根治術後早期死亡的危險因素.結論 臨床上可根據患兒年齡、術前血氧飽和度、Nakata指數、體外循環時間及術後併髮癥預測TOF根治術後早期死亡的危險性.
목적 탐토소인법락사련증(tetralogy of Fallot,TOF)수술후조기사망적위험인소,이제고수술성공솔,강저수술병사솔.방법 2003년1 월지2010년12월기간재성도심혈관병의원행TOF근치술환인191례,기중남142례,녀49례;년령4개월～12세.수집소유환인술전、술중화술후적림상자료,분석영향TOF수술후조기사망적위험인소.결과 191례환인,위술기사망6례(3.14％),사우수술후감염합병다기관공능쇠갈3례,저심배혈량종합정2례,뇌부병발증1례.기중≤6개월환인병사솔6.67％(2/30),6개월～3세환인병사솔1.41％ (1/71),3～12세환인병사솔3.33％ (3/90).다인소Logistic회귀분석결과표명,년령≤6개월(OR=4.606,95％CI 1.811 ～11.719,P＜0.05)、술전혈양포화도＜70％(OR=0.982,95％ CI 0.501 ～ 1.932,P＜0.01)、Nakata지수＜140mm2/m2(OR=16.960,95％CI 1.414 ～ 150.390,P＜0.01)、체외순배시간＞150 min(OR=4.398,95％CI2.091 ～9.216,P＜0.01)급술후다기관공능쇠갈(OR=4.872,95％CI 2.583 ～ 9.192,P＜0.05)시소인TOF근치술후조기사망적위험인소.결론 림상상가근거환인년령、술전혈양포화도、Nakata지수、체외순배시간급술후병발증예측TOF근치술후조기사망적위험성.
Objective To analyze the risk factors for perioperative mortality in children after total correction of tetralogy of Fallot (TOF),in order to provide better operation and decrease the mortality rate.Methods We enrolled 191 TOF patients including 142 males and 49 females at Chengdu Cardiovascular Hospital between Jan 2003 and Dec 2010.The age ranged from 4 months to 12 years.Preoperative,perioperative and postoperative clinical data of all patients were corrected and the risk factors for mortality after total correction of TOF were analyzed.Results Among all the 191 cases,6 cases death (3.14％) occurred in early postoperative,the main causes of death were postoperative infection with multiple organ failure (3 cases),low cardiac output syndrome (2 cases),cerebral complications (1 cases).Among them,2 children (6.67％,2/30) died in age≤6 months,1 child (1.41％,1/71)died in age ranged from 6 months to 3 years,3 children (3.33％,3/90) died in age ranged from 3 years to 12 years.The results of logistic regression and model selection indicated that age ≤ 6 months (OR =4.606,95 ％ CI 1.811 ～ 11.719,P ＜ 0.05),percutaneous oxygen saturation ＜ 70％ before operation (OR =0.982,95％ CI 0.501 ～ 1.932,P ＜ 0.01),Nakata index ＜140 mm2/m2(OR =16.960,95％ CI 1.414 ～ 150.390,P ＜ 0.01),cardiopulmonary bypass time ＞ 150 min (OR =4.398,95 ％ CI 2.091 ～ 9.216,P ＜ 0.01) and multiple organ failure (OR =4.872,95 ％ CI 2.583 ～9.192,P ＜0.05)were risk factors for early postoperative death after total correction of TOF.Conclusion Postoperative mortality in children after total correction of TOF can be predicted by risk factors of age,percutaneous oxygen saturation,Nakata index,cardiopulmonary bypass time,and multiple organ failure.
