上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (9): 1266-.doi: 10.3969/j.issn.1674-8115.2011.09.012

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先天性心脏病体肺分流术后早期失败危险因素分析

徐卓明, 杨 琦, 郭林林, 苏肇伉   

  1. 上海交通大学 医学院附属上海儿童医学中心心脏中心重症监护病房, 上海 200127
  • 出版日期:2011-09-28 发布日期:2011-09-27
  • 通讯作者: 苏肇伉, 电子信箱: zknl1967@yahoo.com.cn。
  • 作者简介:徐卓明（1968—）, 女, 主任医师, 博士；电子信箱: zmxyfb@yahoo.com.cn。

Risk factors for early failure after systemic-to-pulmonary artery shunt in congenital heart disease

XU Zhuo-ming, YANG Qi, GUO Lin-lin, SU Zhao-kang   

  1. Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-09-28 Published:2011-09-27

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摘要：

目的 分析青紫型先天性心脏病（CHD）行体肺分流术后早期失败的危险因素。方法 对接受体肺分流术的73例青紫型CHD患儿的病史资料进行回顾性分析。搜集患儿围术期的客观指标，分别采用χ2检验和Logistic回归对体肺分流术后早期失败事件进行单因素和多因素分析。结果 术后14例患儿发生早期失败。χ2检验结果显示：肺动脉闭锁/室间隔完整、年龄≤60 d、体外循环下手术、术中同期行肺动脉扩大术和术后正性肌力药物评分最大值（ISmax）>20是影响患儿早期失败的相关危险因素；Logistic回归分析显示：术中同期行肺动脉扩大术及术后ISmax>20是早期失败的独立危险因素。结论 对于存在体肺分流术后早期失败危险因素的青紫型CHD患儿，体肺分流术后早期应加强监护，以减少术后早期失败的发生。

关键词: 体肺分流术, 早期失败, 危险因素, 先天性心脏病

Abstract:

Objective To analyse the risk factors for the early failure of systemic-to-pulmonary artery shunt in cyanotic congenital heart disease (CHD). Methods The clinical data of 73 patients with cyanotic CHD undergoing systemic-to-pulmonary artery shunt were retrospectively analysed. The perioperative objective parameters were collected. Univariant analysis was performed with Chi-square test and multivariate analysis was carried out with Logistic regression analysis to seek the risk factors for early failure after systemic-to-pulmonary artery shunt. Results Fourteen patients experienced early failure. Chi-square test indicated that pulmonary atresia/intact ventricular septum, age no more than 60 d, long time of cardiopulmonary bypass, pulmonary artery enlargement and higher maximal inotrope score (ISmax>20) after surgery were associated with early failure. Logistic regression analysis revealed that pulmonary artery enlargement and ISmax>20 after surgery were independent risk factors for early failure. Conclusion For patients with cyanotic CHD having risk factors for early failure after systemic-to-pulmonary artery shunt, the management of intensive care after systemic-to-pulmonary artery shunt should be enhanced to reduce the incidence of early failure.

Key words: systemic-to-pulmonary artery shunt, early failure, risk factor, congenital heart disease