儿童先天性心脏病经导管封堵术后死亡的影响因素分析

目的 分析儿童先天性心脏病（CHD）经导管封堵术后死亡的影响因素,以期为临床诊疗提供科学依据。方法选取2019年12月至2021年3月就诊于我院的222例CHD患儿作为研究对象,根据术后死亡情况将其分为死亡组（36例）和生存组（186例）。比较两组患儿手术前、后的右心房直径（RAD）、右心室内径（RVD）、左心室间隔厚度（LVST）、二尖瓣口血流速度（MV）、左心房内径（LAD）、左心室内径（LVD）、主动脉瓣口流速（AV）、左心室射血分数（LVEF）;采用单因素、多因素Logistic回归分析CHD患儿经导管封堵术后死亡的影响因素;建立CHD患儿术后死亡风险预测模型,并给予模型校准和ROC曲线评价。结果 手术前,两组的RAD、RVD、LVST、MV、LAD、LVD、AV、LVEF比较,差异均无统计学意义（P>0.05）;手术后,两组的RAD、RVD、LAD、LVD均减小,且死亡组小于生存组,差异具有统计学意义（P<0.05）;手术后,两组的LVST、MV、AV、LVEF均增大,且生存组大于死亡组,差异具有统计学意义（P<0.05）。经导管封堵术后死亡36例,占比为1...

Analysis of influencing factors of death after transcatheter closure of congenital heart disease in children

Objective To analyze the influencing factors of death after transcatheter closure of congenital heart disease(CHD) in children,in order to provide scientific basis for clinical diagnosis and treatment.Methods A total of 222 children with CHD admitted in our hospital from December 2019 to March 2021 were selected as the study objects.According to postoperative death,the children were divided into death group(36 cases) and survival group(186 cases).Right atrial diameter(RAD),right ventricular diameter(RVD),left ventricular septal thickness(LVST),mitral valve orifice blood flow velocity(MV),left atrium diameter(LAD),left ventricular diameter(LVD),aortic vawe(AV) and left ventricular ejection fraction(LVEF) were compared between the two groups before and after surgery.Univariate and multivariate Logistic regression were used to analyze the the influencing factors of death after transcatheter closure of CHD in children.The risk prediction model of death after surgery in children with CHD was established,and the model calibration and ROC curve evaluation were performed.Results Before surgery,there were no significant differences in RAD,RVD,LVST,MV,LAD,LVD,AV and LVEF between the two groups(P>0.05);after surgery,RAD,RVD,LAD and LVD decreased in both groups,and those in the death group were smaller than the survival group,and the differences were statistically significant(P<0.05);after surgery,LVST,MV,AV and LVEF increased in both groups,and those in the survival group were larger than the death group,and the differences were statistically significant(P<0.05).Thirty-six cases died after transcatheter closure,accountting for 16.22%.Multivariate Logistic regression analysis showed that ventilator catheterization time,age,low cardiac discharge syndrome,non-invasive ventilation and reintubation were influencing factors for death after transcatheter closure in CHD children(OR=1.625,2.013,2.241,0.901,1.963,P<0.05);the AUC of the line graph prediction model was 0.818(95%CI:0.752-0.913),and the prediction accuracy was 85.31%.Conclusion Postoperative death caused by transcatheter closure in children with CHD was the result of synergistic effects of multiple factors,among which,ventilator catheterization time > 3 d,age < 6 years old,low cardiac discharge syndrome,not used non-invasive ventilation,and reintubation were significantly associated with death.