先天性心脏病患者经外科手术治疗的疗效及安全性影响因素研究

目的研究先天性心脏病(以下简称先心病)患者经外科手术治疗的疗效及安全性影响因素。方法选取2018年1月至2019年12月在梅州市人民医院心脏大血管外科治疗的100例先心病患者作为研究对象,将所有受试者按照是否发生并发症分为并发症组10例与无并发症组90例。分析所有受试者接受一期根治术后的疗效相关指标,包括体外循环时间、主动脉阻断时间、呼吸机使用时间、监护室停留时间及住院时间等。比较两组基线资料及相关手术指标情况,并作多因素Logistic回归分析,明确影响并发症的独立危险因素。结果100例患者均在体外循环下手术,体外循环时间为(61.69±26.32)min,主动脉阻断时间为(37.36±21.60)min,呼吸机使用时间为(17.98±24.49)h,监护室停留时间为(1.43±1.28)d,住院时间为(18.03±6.09)d。并发症发生率为10.00%(10/100),包括1例室间隔缺损残余瘘,1例传导阻滞,2例右室流出道残余梗阻,3例肺部感染,1例切口感染,1例术后急性心功能不全,1例心脏术后急性肾损伤。并发症组体外循环时间、主动脉阻断时间、呼吸机使用时间、监护室停留时间及住院时间高于无并发症组(均P<0.05)。以并发症为因变量,体外循环时间、主动脉阻断时间、呼吸机使用时间、监护室停留时间为自变量,自变量赋值体外循环时间、主动脉阻断时间、呼吸机使用时间、监护室停留时间均为原值输入经多因素Logistic回归分析,结果体外循环时间、主动脉阻断时间、呼吸机使用时间、监护室停留时间是先心病患者经外科手术治疗并发症发生的独立危险因素(P<0.05)。结论先心病患者经外科手术治疗的效果较好,随着体外循环时间、主动脉阻断时间、监护室停留时间、呼吸机使用时间的逐渐延长,患者并发症发生风险随之增大,值得临床推广应用。

Logistic regression analysis of effect and safety factors of surgical treatment in patients with congenital heart disease

【Objective】To study the effect and safety factors of surgical treatment for patients with congenital heart disease.【Methods】A total of 100 patients with congenital heart disease who received surgical treatment in our hospital from January 2018 to December 2019 were selected as subjects.All subjects were analyzed for the outcome indicators after primary radical resection,including extracorporeal circulation time,aortic occlusion time,ventilator use time,ICU stay time,hospital stay,etc.All subjects were divided into complication group and non-complication group according to whether complications occurred or not.The baseline data and relevant surgical indicators of the two groups were compared,and multivariate logistic regression analysis was performed to identify the independent risk factors for complications.【Results】All the 100 patients recieved surgical treatment under cardiopulmonary bypass.The extracorporeal circulation time was 61.69±26.32 min,aorta occlusion time was 37.36±21.60 min,ventilator use time was 17.98±24.49 h,ICU stay time was 1.43±1.28 d,and the hospital stay was 18.03±6.09 d.The incidence of complications was 10.00%(10/100),including 1 case of residual fistula of the ventricular septal defect,1 case of atrioventricular block,2 cases of residual obstruction of the right ventricular outflow tract,3 cases of pulmonary infection,1 case of incision infection,1 case of postoperative acute cardiac insufficiency,and 1 case of postoperative acute renal injury.The duration of extracorporeal circulation,the duration of aortic occlusion,the duration of ventilator use,the duration of stay in custody and the duration of stay in hospital were significantly higher in the complication group than in the non-complication group(all P<0.05).The complications was considered as a dependent variable,extracorporeal circulation time,aortic occlusion time,ventilator use time,care unit residence time were considered as independent variables and independent variable assignment was as follows:the time of extracorporeal circulation,the time of aortic occlusion,the time of ventilator use and the time of stay in the custody ward were all input with the original value.After multivariable logistic regression analysis,extracorporeal circulation time,aortic occlusion time,ventilator use time,care unit stay time were independent risk factors for postoperative complications in patients with congenital heart disease(all P<0.05).【Conclusion】Surgical treatment of patients with congenital heart disease has a good effect.With the gradual extension of extracorporeal circulation time,aortic occlusion time,custody time and ventilator use time,the risk of complications increases,and surgical treatment is worthy of clinical promotion and application.