影响大动脉转位术死亡率的危险因素分析

目的分析大动脉转位术（arterial switch operation，ASO）治疗完全性大动脉错位（complete transposition of the great arteries，TGA）的手术结果，探讨影响死亡率的危险因素。方法收集2003年1月至2004年12月期间，我院对67例TGA患者施行ASO的临床资料，包括住院病历、超声心动图和手术记录。应用x^2检验和logistic多变量回归分析对患者的手术年龄、体重、诊断、冠状动脉分型、体外循环时间、主动脉阻断时间、停循环时间、术后呼吸机辅助时间、延迟关胸等因素进行统计分析，分析影响死亡率的危险因素。结果施行ASO的67例TGA患者中，围手术期死亡5例（7．5％）。单变量分析结果表明，影响ASO死亡率相关的危险因素有：年龄（P=0．004）、体重（P=0．042）、冠状动脉分型（P=0．006）和体外循环时间（P=0．048）。伴有室间隔缺损（ventricular septal defect，VSD）的患者（TGA／VSD）术后住心脏监护室（CICU）时间（P=0．004）和术后住院时间（P=0．007）明显长于室间隔完整（intact ventricular septum，IVS）的患者（TGA／IVS）。logistic多变量回归分析结果表明，患者手术时年龄（P=0．012）、冠状动脉畸形（P=0．001）和较长的体外循环时间（P=0．002）是影响ASO死亡率的危险因素。结论对TGA患者及时施行ASO可获得良好的临床效果，患者手术时年龄、冠状动脉畸形和较长的体外循环时间是影响死亡率的危险因素。

Investigation of Risk Factors Influencing the Mortality of the Arterial Switch Operation

Objective To analyze the outcome of arterial switch operation(ASO) for surgical repair of complete transposition of the great arteries(TGA),and to investigate the risk factors influencing the mortality of ASO.Methods The clinical data of patients suffered from TGA and treated with ASO from the January 2003 to December 2004,and the clinical records in hospital including echocardiogram and operation record were collected.The clinical data were analyzed by chi-squared test and logistic multivariable regression analysis,including the age undergone operation,body weight,diagnosis,anatomic type of coronary artery,cardiopulmonary bypass time,aortic cross-clamping time,circulation arrest time,assisted respiration time after operation,the delayed closure of sternum and so on.The risk factors influencing the early mortality of the ASO were analyzed.Results Sixty seven patients were operated with ASO,five patients died during the peri-operative period.The outcome of univariate analysis indicated that risk factors influencing the mortality of ASO included: age(P=0.004),body weight(P=0.042),anatomic type of coronary artery(P=0.006) and extracorporeal circulation time(P=0.048),the length of the CICU stay(P=0.004) and the hospital stay(P=0.007) after operation in the TGA/VSD patients were longer than those in TGA/IVS patients.The logistic multivariable regression analysis indicated that the age at operation(P=0.012),coronary arteries anomaly(P=0.001)and the longer cardiopulmonary bypass time(P=0.002) were correlated with the increase of death rate.Conclusion It could be good results for TGA patients who was repaired with ASO.The age at operation,the coronary arteries anomaly and the longer cardiopulmonary bypass time are the risk factors influencing the mortality.