降低复杂紫绀型先天性心脏病体-肺动脉分流术后早期死亡率的探讨

目的 探讨降低复杂紫绀型先天性心脏病体-肺动脉分流术后早期死亡率的有效措施。 方法 回顾性分析217例复杂紫绀型先天性心脏病患者施行体-肺动脉分流术的临床资料,探讨降低死亡率的相关措施。其中男101例,女106例,年龄3个月～27岁。体重3.5 kg～54 kg。 结果 中央分流术(Waterston)115例,改良Blalock-Taussig分流术(B-T分流)74例,墨尔本分流28例。术后早期死亡16例(7.4%)。结论 (1)术前积极改善心脏功能,严格掌握手术适应证;(2)合理的手术方法,选择合适大小的分流管;(3)及时纠治并发症;(4)早期抗凝;(5)加强术后监护及综合治疗均为提高该手术成功率的因素。     

新生儿持续肺动脉高压死亡危险因素分析

目的 探讨影响新生儿持续肺动脉高压(PPHN)死亡的危险因素.方法 选择2011年1月至2020年10月,中山大学附属江门医院收治的236例PPHN新生儿进行回顾性分析,死亡的25例为观察组,存活的211例为对照组.采用单因素及二元Logistic回归方法分析各临床指标对患儿预后的影响.结果 PPHN死亡率为10.6％...     

大动脉转位患者动脉调转术后死亡的危险因素分析

目的 分析接受动脉调转术(ASO)治疗大动脉转位(TGA)患者发生住院期间死亡的危险因素.方法2004年1月至2007年12月,入选169例实施ASO的TGA患者,其中男性129例,女性40例,年龄(11.71±26.3)个月.患者分为室间隔完整组(室间隔完整型TGA患者56例)和室间隔缺损组(室间隔缺损型TGA患者113例).对ASO术后发生住院期间死亡的危险因素进行多元logistic回归分析.结果ASO术后发生住院期间死亡19例(11.24%),住院期间病死率由2004年的16.67%下降到2007年的3.92%.2004至2007年,室间隔完整组与室间隔缺损组各年的住院期间病死率差异均无统计学意义.多元logistic回归分析显示,ASO治疗TGA后住院期间死亡的危险因素为:体重≤3 kg(OR:4.571,P=0.0409)、合并室间隔缺损(OR:4.444,P=0.0406)、复杂畸形TGA(OR:4.321,P=0.0140)、Planche分型为非正常型(OR:4.867,P=0.0104)、Leiden分型为非A型(OR:3.045,P=0.0243).结论体重≤3 kg、合并室间隔缺损、复杂畸形TGA、冠状动脉异常是ASO治疗TGA后发生住院期间死亡的危险因素.

Abstract：

Objective To analyze the in-hospital mortality and factors affecting in-hospital mortality for patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO).Methods Between January 2004 and December 2007, ASO was performed in 169 patients [129 male, 40 female; mean age (11.71± 26. 3) months] with TGA. The patients were divided in intact ventricular septum group( n = 56): TGA with intact ventricular septum and ventricular septal defect group (n = 113 ):TGA with ventricular septal defect. Multiple logistic regression analysis was performed to identify the risk factors of in-hospital mortality. Results The overall in-hospital mortality was 11.24% (19/169). The yearly in-hospital mortality was similar between intact ventricular septum group and ventricular septal defect group. With the improvement of perioperative treatment, the in-hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The multivariate analysis revealed that body weight ≤3 kg( OR:4. 571, P =0. 0409), complicating ventricular septal defect( OR:4. 444,P =0. 0406), complex TGA( OR:4. 321 ,P =0. 0140), coronary anomalies( OR:4. 867,P =0. 0104) and non-type A coronary arteries( OR:3. 045,P =0. 0243) were independent predictors for poor early postoperative survival. Conclusion Body weight ≤3 kg,complicating ventricular septal defect, complex TGA, coronary anomalies are independent predictors for increased in-hospital mortality in patients with transposition of TGA and undergoing arterial switch operation.     

大动脉转位患者动脉调转术后死亡的危险因素分析

Objective To analyze the in-hospital mortality and factors affecting in-hospital mortality for patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO).Methods Between January 2004 and December 2007, ASO was performed in 169 patients [129 male, 40 female; mean age (11.71± 26. 3) months] with TGA. The patients were divided in intact ventricular septum group( n = 56): TGA with intact ventricular septum and ventricular septal defect group (n = 113 ):TGA with ventricular septal defect. Multiple logistic regression analysis was performed to identify the risk factors of in-hospital mortality. Results The overall in-hospital mortality was 11.24% (19/169). The yearly in-hospital mortality was similar between intact ventricular septum group and ventricular septal defect group. With the improvement of perioperative treatment, the in-hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The multivariate analysis revealed that body weight ≤3 kg( OR:4. 571, P =0. 0409), complicating ventricular septal defect( OR:4. 444,P =0. 0406), complex TGA( OR:4. 321 ,P =0. 0140), coronary anomalies( OR:4. 867,P =0. 0104) and non-type A coronary arteries( OR:3. 045,P =0. 0243) were independent predictors for poor early postoperative survival. Conclusion Body weight ≤3 kg,complicating ventricular septal defect, complex TGA, coronary anomalies are independent predictors for increased in-hospital mortality in patients with transposition of TGA and undergoing arterial switch operation.     

大动脉转位患者动脉调转术后死亡的危险因素分析

Objective To analyze the in-hospital mortality and factors affecting in-hospital mortality for patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO).Methods Between January 2004 and December 2007, ASO was performed in 169 patients [129 male, 40 female; mean age (11.71± 26. 3) months] with TGA. The patients were divided in intact ventricular septum group( n = 56): TGA with intact ventricular septum and ventricular septal defect group (n = 113 ):TGA with ventricular septal defect. Multiple logistic regression analysis was performed to identify the risk factors of in-hospital mortality. Results The overall in-hospital mortality was 11.24% (19/169). The yearly in-hospital mortality was similar between intact ventricular septum group and ventricular septal defect group. With the improvement of perioperative treatment, the in-hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The multivariate analysis revealed that body weight ≤3 kg( OR:4. 571, P =0. 0409), complicating ventricular septal defect( OR:4. 444,P =0. 0406), complex TGA( OR:4. 321 ,P =0. 0140), coronary anomalies( OR:4. 867,P =0. 0104) and non-type A coronary arteries( OR:3. 045,P =0. 0243) were independent predictors for poor early postoperative survival. Conclusion Body weight ≤3 kg,complicating ventricular septal defect, complex TGA, coronary anomalies are independent predictors for increased in-hospital mortality in patients with transposition of TGA and undergoing arterial switch operation.     

经颈静脉肝内门体分流术后早期肝性脑病的危险因素

目的 研究经颈静脉肝内门体分流术(TIPS)术后早期肝性脑病(HE)的危险因素,并观察术后HE与患者长期生存情况的相关性.方法 收集2003年1月-2008年12月接受TIPS治疗食管胃底静脉曲张出血或顽固性腹水的患者.对术后3个月内有HE(术后早期HE组)和术后3个月内无HE(无术后早期HE组)的两组患者的临床特征进行单因素分析和多因素logistic回归分析,并对两组患者的生存情况进行分析比较.结果 共收集190例患者资料,中位随访时间为30.5个月(四分位间距为30个月).术前血清纤维蛋白酶原(OR=0.414,P=0.023)及Child-Pugh评分(OR=1.744,P=0.024)与术后早期HE相关.并且术后早期HE组患者与无术后早期HE组患者的3年累积生存率分别为44.9%(95%可信区间为53.5%～36.3%)和79.5%(95%可信区间为83.2%～75.7%).结论 TIPS术前高Child-Pugh评分及低血清纤维蛋白酶原的患者术后3个月内发生HE的可能性大.发生术后早期HE的患者比不发生术后早期HE患者长期累积生存率低.

Abstract：

Objective To identify the risk factors of early post-TIPS hepatic encephalopathy (HE) and the long-time survival of patients with or without early post-TIPS HE. Methods Consecutive cirrhotic patients who underwent TIPS for variceal rebleeding or refractory ascites in our center from January 2003 to December 2008 were included in this study. More than 60 clinical characteristics were enrolled in univariate analysis and logistic regression analysis to define the risk factors of HE in 3 months after TIPS procedure (early post-TIPS HE). The long-time survival of patients with or without early post-TIPS HE was compared by Cox regression with several covariates. Results According to our inclusion criteria, 190 patients were included. The median follow-up was 30.5 months. Lower serum concentration of fibrinogen and higher Child-Pugh score were the independent risk factors for suffering early post-TIPS HE. Patients without early post-TIPS HE after TIPS showed better prognosis than those with early post-TIPS HE after TIPS (P = 0.044). Conclusion Patients with lower serum fibrinogen and higher Child-Pugh score before TIPS might be more probably attacked by early post-TIPS HE which indicated worse long-term survival.     

发绀型先天性心脏病改良体-肺动脉分流术中血流动力学变化

目的:使用压力记录分析法(PRAM)监测发绀型先天性心脏病患儿改良体-肺动脉(m BT)分流术中血流动力学的变化,分析其临床应用价值,并以此作为选择容量治疗或强心治疗的依据。方法:选择28例择期行m BT分流术的先天性心脏病患儿,主要诊断法洛四联症19例,肺动脉狭窄+室间隔缺损6例,肺动脉闭锁+室间隔缺损3例,月龄2~24个月,中位月龄10.6(6.2,18.9)个月,体质量(10.5±5.1)kg,Nakata指数平均(125±41)mm~2/m~2。在切皮前(T0)、切心包1 min(T1)、部分阻断肺动脉1 min和10 min(T2、T3)、部分阻主动脉后(T4)、人工血管开放通血1 min和10 min(T5、T6)、术毕(T7),记录循环周期效率(CCE)、心排血指数(CI)、心每搏指数(SVI)、收缩压(SBP)、重脉压与舒张压差值(Pdic-a)、压力升支最大斜率(dp/dt_(max))、体循环阻力指数(SVRI)、脉压变异度(PPV)。结果:各时间点dp/dt_(max)的平均值均>1.0 mm Hg/ms(1mm Hg=0.133k Pa)。人工血管通血前(T0-T4),T3点CCE、CI、SVI均处于最低点,其中CCE_(T3)明显低于CCE_(T0-T1)(P均<0.05),CI_(T3)明显低于CI_(T0-T2)(P均<0.01),SVI_(T3)明显低于SVI_(T0-T2)(P<0.01,P<0.01和P<0.05);Pdic-a_(T4)处于最低点,显著低于Pdic-a_(T0-1)(P<0.01和P<0.05);SVRI_(T3)处于最高点,明显高于SVRI_(T0)(P<0.01)。人工血管通血后(T5-T7),T5点CCE、CI、SVI、Pdic-a均处于最低点,其中CCE_(T5)明显低于CCE_(T7)(P<0.05),CI_(T5)明显低于CI_(T6-T7)(P均<0.05),SVI_(T5)明显低于SVI_(T6-T7)(P均<0.05),Pdic-aT5明显低于Pdic-aT6-7(P<0.01);PPVT5明显高于PPVT6-T7(P<0.01)。在T6和T7点,PPV与Pdic-a呈显著负相关(r=-0.51,r=-0.53,P均<0.01)。结论:m BT术中血流动力学维护重点,在人工血管通血前以强心为主,应用正性肌力药维护心功能,在人工血管通血后通过扩容维护有效循环血容量。通过CCE、CI、SVI、dp/dt_(max)、PPV、Pdic-a等血流动力学监测指标,精准判断液体治疗和应用正性肌力药治疗的权重,从而积极防治患儿术中低氧血症,稳定血流动力学状态。     

体-肺动脉分流术在建立先天性心脏病动物模型中的应用进展

先天性心脏病是导致儿童死亡的一个重要病因,为研究先天性心脏病的病理生理机制,建立稳定可靠的动物模型相当重要,建立体-肺动脉分流是模拟左向右分流型先天性心脏病的关键技术.现从外科建立分流技术的发展出发,介绍体-肺动脉分流对于建立动物模型的意义,以及以介入方式建立此分流的发展和在不同模型中的应用.     

急性心肌梗死院内死亡危险因素分析

目的:探讨急性心肌梗死(AMI)病人院内死亡的独立危险因素。方法:回顾性分析我院2011~2013年在我院住院期间,确诊为AMI的患者614例的临床资料,根据AMI患者住院期间存活与否,分为死亡组(62例)和存活组(552例),用单变量和多变量Logistic回归分析所有患者的基线特征因素和治疗方法与院内死亡的关系。结果:62例死亡患者平均年龄(66.58±12.87)岁,男性39例(62.9%),院内死亡率为10.10%(62/614),多变量Logistic回归分析筛选出与AMI院内死亡相关的独立危险因素为:年龄(OR=3.065,95%CI:1.188~7.915)、女性(OR=2.775,95%CI:1.200~6.419)、心率(OR=2.836,95%CI:1.405~5.722)、血糖(OR=1.943,95%CI:1.186~3.184)、Killip IV级(OR=1.744,95%CI:1.211~2.513)、3支或左主干病变(OR=3.157,95%CI:1.244~8.014),P<0.05~<0.01。结论:高龄、女性、心率增快、入院血糖水平高、KillipIV级、3支或左主干病变可能是急性心肌梗死院内死亡的独立危险因素。     

老年多器官功能衰竭的死亡危险因素分析

老年多器官功能衰竭(MOFE)一旦发生,则病情进展迅速,往往在短时间内同时或序贯出现≥2个器官功能衰竭,是老年患者重要死因.     

成人心脏外科术后感染调查及危险因素分析

据报道,心脏外科手术后感染的发病率达5％～21％。对心脏外科术后感染情况进行分析,调查引起感染的病原菌及其耐药情况,掌握本单位本地区耐药菌的发生和发展的趋势是非常必要的,可以对临床抗生素的应用提供指导,制订治疗感染的经验性治疗方案,减少耐药菌的产生。     

Incidence and risk factors of delirium in patients after cardiac surgery: Modifiable and non-modifiable factors

BackgroundPost cardiac surgery delirium is a severe complication. This study tried to evaluate the early postoperative delirium risk factors and to identify which of them can be modified in order to optimize perioperative management.MethodsIt is a prospective observational study. 250 consecutive cardiac surgery patients took part in the study. Cardiac surgery, the anesthetic regiment and the postoperative management were standardized. The incidence and the risk factors of the postoperative delirium were analyzed by univariate and multivariate analysis. Delirium was assessed with screening scale – The Confusion Assessment Method for the intensive care unit every 12 h postoperatively.ResultsDelirium developed in 52 patients (20.8%). Univariate analysis of the variables confirmed that older age (p = 0.0001), the higher EuroSCORE II value (p = 0.0001), longer CPB time (p = 0.0001), longer ACC time (p = 0.0001), and the sufentanil dose (p = 0.010) were strongly independently associated with postoperative delirium. The benzodiazepine administration was shown to be an intermediate predictor for developing postoperative delirium (p = 0.055).ConclusionsAdvanced age, higher EuroSCORE II value, longer CPB and ACC times, and higher sufentanil doses during anesthesia were all predictors for the development of postoperative delirium. The only modifiable risk factor was the use of larger doses of sufentanil which is related with the duration of the operation. New preventive strategies and use of reduced dose of sufentanil intraoperatively, or the use of different opioid should be studied and applied in order to reduce the incidence of the postoperative delirium.     

心脏直视术后中老年患者纵隔感染的危险因素分析

目的 探讨经心脏直视术后纵隔感染的危险因素及临床意义.方法 我院于2010-2012年间共施行1369例心脏直视手术,选取102例经胸骨正中切口患者,其中61例为术后出现纵隔感染患者,将102例患者的年龄、性别、吸烟史、肥胖、糖尿病、高血压、术后肺部感染、心脏病家族史、体外循环时间进行logistic分析,筛选出纵隔感染的危险因素.结果 吸烟史、糖尿病、术后肺部感染、体外循环时间为心脏直视术后纵隔感染的危险因素.结论 充分评估纵隔感染的危险因素,以便术前及术后采取针对化治疗措施,为避免术后纵隔感染提供临床参考依据.     

心脏手术后患者院内获得性肺炎的危险因素

心脏手术是心血管疾病的主要干预手段之一,其术后感染并发症最常见为院内获得性肺炎。本文综述了近年来国内外多篇关于心脏手术患者发生院内获得性肺炎的危险因素的研究报道。主要的危险因素包括:气管插管、机械通气辅助呼吸、仰卧体位、抑酸药物滥用、停留鼻胃管、吞咽功能障碍或神经功能障碍、镇痛药物使用、输血、手术时间或体外循环时间较长、急诊手术、高血压、术后心房颤动、ICU停留时间延长、低白蛋白血症、C反应蛋白升高、术前广谱抗生素的使用、高龄、慢性心功能不全、糖尿病、肝硬化及慢性肾衰竭等。     

体外循环心脏术后急性肝功能损害的危险因素分析

目的：通过分析体外循环心脏手术后肝功能损害的危险因素，认识心脏手术后肝功能损害的发生规律及特点。方法：对397例体外循环心脏手术后发生肝功能损害的相关因素进行单因素和多因素分析。结果：单因素分析显示：高龄、风湿性心脏病、慢性病毒性肝炎、术前右心衰、肝淤血、黄疸、腹水、术后严重感染、乳酸酸中毒、低心排血量及低氧血症等因素可能会导致术后急性肝功能损害的发生；多因素分析显示：术前就有肝功能损害、手术中体外循环时间长（超过2h）、手术出血多导致血制品输入量超过1000ml、术后低心排血量以及低氧血症是术后急性肝功能损害发生的独立危险因素。结论：体外循环心脏手术后肝功能损害是多种因素共同作用的结果，应提高对围术期肝功能损害危险因素的认识，正确指导临床治疗，从而避免术后急性肝功能衰竭的发生。     

心脏永久性起搏器术后上肢深静脉血栓形成的危险因素分析

目的 调查和分析心脏永久性起搏器置入术后患者发生上肢深静脉血栓形成的相关危险因素,为临床预防提供理论依据.方法 研究分析97例心脏永久性起搏器置入术后患者发生上肢深静脉血栓形成的危险因素,单因素分析采用x2检验,有统计学意义的因素代入多因素非条件logistic回归分析进行分析.结果 临时起搏器置入（OR=6.314）、房颤病史（OR=2.583）、感染（OR=8.368）、吸烟（OR=1.639）、心功能≥NYHAⅢ级（OR=1.972）为心脏永久性起搏器置入术后患者上肢深静脉血栓形成的危险因素.抗凝治疗（β=-1.761;OR=2.169）是心脏永久性起搏器置入术后患者上肢深静脉血栓形成的保护因素.结论 临时起搏器置入、房颤病史、感染、吸烟、心功能≥NYHAⅢ级是心脏永久性起搏器置入术后患者发生上肢深静脉血栓形成的独立危险因素.     

艾滋病合并马尔尼菲青霉菌病患者死亡危险因素分析

目的探讨艾滋病(AIDS)合并马尔尼菲青霉菌病(PSM)的死亡危险因素。方法采用病例对照研究方法,调查2008-01～2009-12广西壮族自治区龙潭医院收治住院的307例AIDS合并PSM患者,通过单因素和多因素非条件Logistic回归分析筛选出导致患者死亡的危险因素。结果 AIDS合并PSM 307例患者中,生存组226例,死亡组81例,死亡率为26.38%。单因素Logistic回归分析显示,感染途径、治疗方案、是否接受过高效抗反转录病毒(HAART)治疗、合并细菌或其它真菌性肺炎、合并耶氏肺孢子虫肺炎(PCP)、中毒性肝炎、白细胞减少、血小板减少、白蛋白减少、血尿素氮升高、血清总胆红素升高等16个因素为死亡的影响因素。多因素分析结果显示,实施氟康唑治疗方案及两性霉素B治疗方案是预后的保护因素,合并PCP、血小板减少、血尿素氮升高、总胆红素升高是死亡的危险因素。结论通过对死亡危险因素的研究,可有针对性采取有效治疗和控制措施.对降低死亡率有重要意义。     

心脏外科术后肺部并发症危险因素分析

目的:分析心脏外科术后肺部并发症的围手术期危险因素及其影响。方法:分析1995年1月～2002年2月间连续2084例正中切口右房-升主动脉体外循环心脏外科手术术前、术中及术后相关因素,观察它们在围手术期肺部并发症中的作用。结果:共有136例肺部并发症(6.5%)。肺部并发症的术前危险因素包括女性(相对危险度OR=1.49)、吸烟(OR=1.64)、慢性阻塞性肺部疾病(OR=2.36),术中危险因素包括应用冷心脏停搏液(OR=1.56),术后危险因素包括需要血管活性药物支持(OR=2.00)、2次开胸(OR=2.08)、主动脉内球囊反搏(OR=2.39)、胸腔积液(OR=2.63)、术后脑血管意外(OR=5.45)、膈神经损伤(OR=8.09)、以及术后肾功能衰竭需用肾透析(OR=12.87)。围手术期肺部并发症不是围手术期死亡的危险因素。结论:心脏外科术后多种围手术期危险因素增加术后肺部并发症的发生,特别是术后脑血管意外、膈神经损伤、以及肾功能衰竭需要肾透析对围手术期肺部并发症的发生影响最为明显。对此类患者需特别注意保护肺功能,以减少并发症的发生。围手术期肺部并发症不是围手术期死亡的危险因素。     

Cardiac surgery in patients with liver cirrhosis: Risk factors for predicting mortality

AIM: To evaluate the results of cardiac surgery in cirrhotic patients and to find the predictors of early and late mortality.METHODS: We included 55 consecutive cirrhotic patients undergoing cardiac surgery between 1993 and 2012. Child-Turcotte-Pugh (Child) classification and Model for End-Stage Liver Disease (MELD) score were used to assess the severity of liver cirrhosis. The online EuroSCORE II calculator was used to calculate the logistic EuroSCORE in each patient. Stepwise logistic regression analysis was used to identify the risk factors for mortality at different times after surgery. Multivariate Cox proportional hazard models were applied to estimate the hazard ratios (HR) of predictors for mortality. The Kaplan-Meier method was used to generate survival curves, and the survival rates between groups were compared using the log-rank test.RESULTS: There were 30 patients in Child class A, 20 in Child B, and five in Child C. The hospital mortality rate was 16.4%. The actuarial survival rates were 70%, 64%, 56%, and 44% at 1, 2, 3, and 5 years after surgery, respectively. There were no significant differences in major postoperative complications, and early and late mortality between patients with mild and advanced cirrhosis. Multivariate logistic regression showed preoperative serum bilirubin, the EuroSCORE and coronary artery bypass grafting (CABG) were associated with early and late mortality; however, Child class and MELD score were not. Cox regression analysis identified male gender (HR = 0.319; P = 0.009), preoperative serum bilirubin (HR = 1.244; P = 0.044), the EuroSCORE (HR = 1.415; P = 0.001), and CABG (HR = 3.344; P = 0.01) as independent risk factors for overall mortality.CONCLUSION: Advanced liver cirrhosis should not preclude patients from cardiac surgery. Preoperative serum bilirubin, the EuroSCORE, and CABG are major predictors of early and late mortality.