6月龄以下危重婴儿室间隔缺损手术治疗的近期预后分析

目的 探讨影响6月龄以下危重婴儿室间隔缺损手术治疗近期预后的相关危险因素.方法 回顾性分析2009年1月至2011年12月我们收治的161例6月龄以下危重室间隔缺损婴儿的手术治疗情况,将全部病例按照近期疗效分为预后好或差两组.分析两组在手术年龄、体重、有无心内合并畸形和气管狭窄、术前感染情况、肺动脉高压程度、转流和主动脉阻断时间、室间隔缺损直径、呼吸机支持时间、胸腔引流量、正性肌力药物评分（inotrope score,IS）、监护时间等方面的差异,将可能的危险因素纳入多因素非条件Logistic回归模型,筛选出影响预后的危险因素. 结果 体重、呼吸机支持时间、胸腔引流量、心内合并的其他畸形、肺动脉高压程度、有无气管狭窄只在单因素分析中有差异.而转流和主动脉阻断时间、IS、监护时间在单、多因素分析中均有不同,P值分别是0.000～0.001、0.000～0.042,差异有统计学意义.结论 转流时间长、主动脉阻断时间短、IS高、监护时间长是影响手术治疗近期预后的主要危险因素.

The recent prognosis after ventricular septal defect operation in critically ill infants

Objetive To analyze the possible risk factors influencing short-term outcome after operation of ventricular septal defect （VSD） in critically ill infants with the age less than 6 months.Methods Between Jan 2009 to Dec 2011,161 operation of VSD in critically ill infants with the age less than 6 months were included in this study,and were divided into two groups by prognosis.Information about preoperative operation and postoperative treatment were collected and double entered into computer using SPSS by two research assistants.Univariate analysis and multivariate logistic regression analysis were used to identify the possible risk factors for short-term prognosis.Results We found that operative weight,ventilation time,amount of postoperative thoracic drainage,malformations in the heart,degree of pulmonary hypertension as well as tracheal stenosis were significantly associated with prognosis of the operation in univariate analysis.Cardiopulmonary bypass and aortic cross-clamping time,inotrope score （IS）,prolonged stay in intensive care unit were significantly associated with prognosis of the operation in multivariate analysis,with P values were 0.000,0.001,0.000,0.042 respectively.Conclusion Cardiopulmonary bypass time,aortic cross-clamping time,IS and prolonged stay in intensive care unit were risk factors of short-term prognosis after surgical treatment.