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小儿法洛四联症根治术后ICU滞留危险因素分析(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第4期
页码:
557-559
栏目:
临床研究
出版日期:
2009-06-25

文章信息/Info

Title:
Risk factors for prolonged stay in intensive care unit in children with tetralogy of Fallot undergoing corrective surgery
作者:
李胜利; 王旭; 贺彦; 刘迎龙; 李守军; 闫军
中国医学科学院阜外心血管病医院小儿心脏中心, 北京 100037
Author(s):
LI Sheng-li;  WANG Xu;  HE Yan;  LIU Ying-long;  LI Shou-jun;  YAN Jun
Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
关键词:
心脏病; 先天性; 儿童; 法洛四联症; 重症监护室; 危险因素
Keywords:
congenital heart disease;  children;  tetralogy of Fallot;  intensive care unit;  risk factor
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的 分析造成小儿法洛四联症（Tetralogy of Fallot,TOF）根治术后ICU滞留的主要影响因素，探讨改进疗效的方法。 方法 将2007年1月~2008年6月连续实施的329例TOF根治患儿，根据术后ICU时间分组，I组为ICU时间<7 d，II组为ICU时间≥7 d。以年龄、性别、体质量、Nakata指数、体外循环时间、跨环补片数等作为观察变量，先对变量进行单因素分析，然后将有意义的变量纳入Logistic回归分析。 结果 术后ICU滞留45例，ICU滞留的直接原因中，最多见的是肺渗出，其次是低心排。I组死亡3例，手术死亡率1％；II组死亡5例，手术死亡率11％(两组差异显著，P<0.01)，单因素分析显示，ICU滞留组与未滞留组比较，其年龄低，Nakata指数小，体外循环时间长，跨环补片例数多，术后呼吸机辅助时间延长，其差异均有统计学意义。 Logistic回归显示：年龄≤6个月，Nakata指数＜140 mm2/m2，体外循环时间>150 min是TOF根治术ICU滞留的危险因素。 结论 年龄偏小，Nakata指数偏低和体外循环时间长是术后ICU滞留的危险因素。
Abstract:
AIM: To analyze the risk factors for prolonged stay in intensive care unit (ICU) after corrective surgery for tetralogy of Fallot (TOF). METHODS: Between January 2007 and June 2008, 329 consecutive patients with TOF undergoing corrective surgery were divided into two groups based on the length of stay in ICU. Prolonged stay in ICU was defined as 7 days or more. Group I was comprised of 284 patients with no prolonged ICU stay. Group II was comprised of 45 patients with prolonged ICU stay. Uni- and multivariate analysis were used to identify risk factors. RESULTS: Univariate analysis showed that group II subjects were younger and the Nakata index was lower compared with those in group I. Ventilation time, bypass time, clamping time, presence of transannular patch and rate of infection were longer or higher in group II than in group I. Logistic regression showed that risk factors for prolonged ICU stay were age ≤6 months, Nakata index <140 mm2/m2 and cardiopulmonary bypass time >150 min. CONCLUSION: Prolonged ICU stay after corrective operation of TOF can be predicted by risk factors. Patients with these risk factors require more pre- and postoperative care to reduce mortality and morbidity and to avoid prolonged postoperative ICU time.

参考文献/References

［1］ Bapat V, Allen D, Young C, et al. Survival and quality of life after cardiac surgery complicated by prolonged intensive care［J］. J Card Surg, 2005, 20(3):212-217.

［2］ Bashour CA, Yared JP, Ryan TA, et al. Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care［J］. Crit Care Med, 2000, 28(12)：3847-3853.

［3］ 刘锦纷,孙彦隽,苏肇伉,等. 2186例小儿法乐四联症外科治疗分析［J］. 上海第二医科大学学报, 2004, 24(3):165-168.

［4］ Chittithavorn V, Rergkliang C, Chetpaophan A, et al. Predicted outcome after repair of tetralogy of Fallot by postoperative pressure ratio between right and left ventricle［J］. J Med Assoc Thai, 2006, 89(1):43-50.

［5］ Blackstone EH, Kirklin JW, Pacifico AD. Decision-making in repair of tetralogy of Fallot based on intraoperative measurements of pulmonary arterial outflow trace［J］. J Thorac Cardiovasc Surg, 1979, 77(4):526-532.

［6］ 朱鲜阳,王淑范,张玉威. 影响法洛四联症患者存活的因素［J］. 心脏杂志, 2004, 16(4):359-361.

［7］ 崔勤,俞世强,赵荣,等. 新天性心脏病患儿围手术期呼吸功能的保护［J］. 心脏杂志, 2006, 18(6): 685-687.

［8］ 刘迎龙，沈向东，李守军，等. 介入及手术联合矫治伴有体肺动脉侧支的肺血减少型先天性心脏病［J］. 中华医学杂志, 2006, 86(4):228-231.

备注/Memo

备注/Memo:
收稿日期：2008-8-26.作者简介：李胜利，主治医师Email:lichamp@yahoo.com
更新日期/Last Update: 2009-06-15