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目的研究与法洛四联症(TOF)一期根治手术早期死亡相关的危险因素。方法回顾1995年4月至2004年3月在复旦大学附属儿科医院心血管中心行一期根治术的TOF病例152例,术后早期死亡17例,对其术前、术中27个可能的危险因素指标与术后早期死亡的关系进行单因素和多因素分析。结果单因素分析结果显示与术后早期死亡有关的指标包括手术时体重、发生青紫年龄、动脉血氧饱和度、升主动脉与肺动脉干直径比AO/MPA、McGoon比值、Nakata指数、肺体循环血流量之比Qp/Qs、右向左分流量占体循环血流量比例(QseQp)/Qs、体肺侧支循环和跨瓣补片。多因素分析结果显示AO/MPA和McGoon比值与手术早期死亡有关。结论肺动脉的发育情况是TOF一期根治术后能否生存的关键。手术病例的选择需要综合考虑多种危险因素。

Primary repair of tetralogy of Fallot: an analysis of risk factors for early postoperative death in 152 patients

Objective To identify risk factors associated with early postoperative death in patients undergoing primary repair of tetralogy of Fallot (TOF).Methods 27 preoperative and intraoperative variables potentially predictive of early postoperative death of 152 patients,who underwent primary repair of TOF between April 1995 and March 2004 at the Cardiovascular Center of Children's Hospital of Fudan University,were analyzed in a univariate and multivariate manner.Results Univariate analysis demonstrated a significant association between early postoperative death and the following variables: weight at the time of surgery,age for cyanosis to be present,SaO_~2 ,AO/MPA,McGoon ratio,Nakata index,Qp/Qs,(Qs-eQp)/Qs,multiple aortopulmonary collateral arteries and transannular patching. In the multivariate model only AO/MPA and McGoon ratio were associated with early postoperative death.Conclusion Pulmonary artery hypoplasia is the most important risk factor for early postoperative death after primary repair of TOF.Multiple risk factors should be considered when the choice of patients for the procedure is made.