完全性大动脉转位一期动脉调转术后ICU延迟恢复的临床特征及影响因素分析

目的 总结完全性大动脉转位(TGA)一期大动脉调转(ASO)术后早期临床特点及围术期处理策略,评价年龄结构及畸形复杂程度对术后恢复进程的影响,并分析导致术后ICU延迟恢复的相关风险因素.方法 回顾性分析2015-2017年我院连续231例行一期ASO手术的TGA患儿临床资料,其中男165例、女66例,年龄3d至10岁....

Clinical characteristics and risk factors for prolonged recovery after one-stage arterial switch operation for patients with transposition of the great arteries

Objective To summarize the early clinical features and perioperative management strategies for patients with transposition of the great arteries(TGA)after one-stage arterial switch operation(ASO),and investigate the risk factors for prolonged recovery in ICU,with a focus on the age structure and deformity complexity.Methods The clinical data of 231 consecutive TGA patients who underwent one-stage ASO were retrospectively analyzed.There were165 males and 66 females,aged from 3 d to 10 years.The patients were sequenced by the length of ICU stay.The time at the 75 th percentile was defined as the critical value for grouping.Patients with an ICU stay time over this point were allocated to a prolonged recovery group(n=54),while the rest were allocated to a normal recovery group(n=177).The perioperative clinical data were compared between the two groups,and the risk factors for prolonged recovery were evaluated.Results About half(49.6%)of the patients received late operation.The mean ICU stay time was 23.9±15.6 d in the prolonged recovery group,and 4.9±2.3 d in the normal recovery group.Complication of aortic arch lesion,delayed chest closure and postoperative pulmonary infection were independent risk factors for prolonged recovery after ASO in ICU.However,late operation had no significant effect on the overall recovery.Conclusion With strict surgery indications and excellent postoperative management,most patients can have satisfactory early-stage outcomes,but are confronted with increased complications,which is associated with prolonged recovery.Complication of aortic arch lesion,delayed chest closure and postoperative pulmonary infection are independent factors for delayed recovery of ASO.