中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
16期
1273-1276
,共4页
黄继红%蔡及明%张海波%周燕萍
黃繼紅%蔡及明%張海波%週燕萍
황계홍%채급명%장해파%주연평
先天性心脏病%心脏手术%危险因素%婴儿,新生
先天性心髒病%心髒手術%危險因素%嬰兒,新生
선천성심장병%심장수술%위험인소%영인,신생
Congenital heart defect%Cardiac surgery%Risk factors%Infant,newborn
目的 分析新生儿先天性心脏病手术治疗的死亡危险度.方法 回顾性分析2011年1月至2013年12月上海交通大学医学院附属上海儿童医学中心231例新生儿先天性心脏病外科治疗死亡危险度.根据先天性心脏手术风险调整-1(RACHS-1)评分对手术方法进行分级,手术时年龄、体质量、急诊手术、体外循环、单心室姑息手术、RACHS-1评分均纳入风险评估.结果 新生儿先天性心脏病患儿手术治疗的总体病死率为9.96％(23/231例),病死率较高的3种手术为单心室姑息手术(25.00％,7/28例)、主动脉弓中断纠治术(21.43％,3/14例)、大动脉换位加室间隔缺损修补手术(13.95％,6/43例),室间隔完整的肺动脉闭锁根治手术仅1例,故未纳入高病死率类别.随着RACHS-1评分的增加,死亡风险增高,RACHS-1评分为2的病死率为6.67％(2/30例),评分3为6.84％(8/117例),评分4为13.75％(11/80例),评分6为50.00％(2/4例).死亡的多因素危险度分析显示:单心室姑息手术年龄、体质量＜3 000 g和RACHS-1评分为死亡的独立危险因素.结论 目前新生儿先天性心脏病手术治疗的总体病死率仍然较高,对于上述高危患儿的进一步、前瞻性研究迫切需要.新生儿期单心室手术策略有待优化.
目的 分析新生兒先天性心髒病手術治療的死亡危險度.方法 迴顧性分析2011年1月至2013年12月上海交通大學醫學院附屬上海兒童醫學中心231例新生兒先天性心髒病外科治療死亡危險度.根據先天性心髒手術風險調整-1(RACHS-1)評分對手術方法進行分級,手術時年齡、體質量、急診手術、體外循環、單心室姑息手術、RACHS-1評分均納入風險評估.結果 新生兒先天性心髒病患兒手術治療的總體病死率為9.96％(23/231例),病死率較高的3種手術為單心室姑息手術(25.00％,7/28例)、主動脈弓中斷糾治術(21.43％,3/14例)、大動脈換位加室間隔缺損脩補手術(13.95％,6/43例),室間隔完整的肺動脈閉鎖根治手術僅1例,故未納入高病死率類彆.隨著RACHS-1評分的增加,死亡風險增高,RACHS-1評分為2的病死率為6.67％(2/30例),評分3為6.84％(8/117例),評分4為13.75％(11/80例),評分6為50.00％(2/4例).死亡的多因素危險度分析顯示:單心室姑息手術年齡、體質量＜3 000 g和RACHS-1評分為死亡的獨立危險因素.結論 目前新生兒先天性心髒病手術治療的總體病死率仍然較高,對于上述高危患兒的進一步、前瞻性研究迫切需要.新生兒期單心室手術策略有待優化.
목적 분석신생인선천성심장병수술치료적사망위험도.방법 회고성분석2011년1월지2013년12월상해교통대학의학원부속상해인동의학중심231례신생인선천성심장병외과치료사망위험도.근거선천성심장수술풍험조정-1(RACHS-1)평분대수술방법진행분급,수술시년령、체질량、급진수술、체외순배、단심실고식수술、RACHS-1평분균납입풍험평고.결과 신생인선천성심장병환인수술치료적총체병사솔위9.96％(23/231례),병사솔교고적3충수술위단심실고식수술(25.00％,7/28례)、주동맥궁중단규치술(21.43％,3/14례)、대동맥환위가실간격결손수보수술(13.95％,6/43례),실간격완정적폐동맥폐쇄근치수술부1례,고미납입고병사솔유별.수착RACHS-1평분적증가,사망풍험증고,RACHS-1평분위2적병사솔위6.67％(2/30례),평분3위6.84％(8/117례),평분4위13.75％(11/80례),평분6위50.00％(2/4례).사망적다인소위험도분석현시:단심실고식수술년령、체질량＜3 000 g화RACHS-1평분위사망적독립위험인소.결론 목전신생인선천성심장병수술치료적총체병사솔잉연교고,대우상술고위환인적진일보、전첨성연구박절수요.신생인기단심실수술책략유대우화.
Objective To analyze the risk factors in the operative mortality in neonates with congenital heart disease.Methods The surgical outcomes of eongenital heart defects in 231 neonates at Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University of Medicine,during Jan.2011 and Dec.2013 were detected for retrospectively.Patients were analyzed according to Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1).The age,weight at operation,emergency operation,cardiopulmonary bypass,single ventricle surgery,and RACHS-1 score were detected for risk assessments.Results Overall mortality of congenital heart defect in neonates was 9.96％ (23/231 cases).The top three procedures for high mortality were single ventricle palliative surgery.(25.00％,7/28 cases),corrective operation of interrupted aortic arch (21.43％,3/14 cases),and arterial switch operation with ventricular septum defect repair (13.95％,6/43 cases).There was only 1 case of pulmonary atresia with intact ventricular septum repair,and the case was not classified into high mortality category.With the elevation of RACHS-1,the mortality increased.The mortality rate was 6.67％ (2/30 cases) in RACHS-1 as category 2,6.84％ (8/117 cases) in 3,13.75％ (11/80 cases) in 4,and 50.00％ (2/14 cases) in 6.Multivariable analvsis of risk factors for death showed that single ventricle palliative operation,body weight less than 3 000 g,and RACHS-1 were independent risk factors for mortality.Conclusions This study shows the surgical mortality in neonates with congenital heart defect is still high.Further prospective analysis of specific treatment strategies for high risk patients above was needed and the strategy for single ventricle operation in neonates should be optimized.
