婴幼儿室间隔缺损合并重度肺动脉高压围手术期预后影响因素分析

目的探讨婴幼儿室间隔缺损合并重度肺动脉高压患者围手术期预后的影响因素，为此类患者的预后判断提供参考。方法选取2004～2012年北京安贞医院40例室间隔缺损合并重度肺动脉高压（PAPm〉50mmHg）的手术治疗患儿，男21例、女19例，年龄（7．2±3.3）岁，体重（19．6±7．1）kg。入选患儿随机分成两组：组Ⅰ（Group=0，n=20，男／女：12／8）经中心静脉持续泵入硝酸甘油；组Ⅱ（Group=1，n=20，男／女：9／11），经中心静脉持续泵人前列腺素E1（PGE1）脂质微球。以气管内插管时间（Tintubation）为因变量（Y），以患者年龄（Age）、体外循环时间（TCPB）、术后平均肺动脉压（PAPm）、术后肺血管阻力指数（PVRI）、术后体循环压力／肺循环压力（Ps/p）、用药分组（Group）、术后左心室每搏功指数（LVSWI）和术后右心室每搏功指数（RVSWI）为自变量（X），采用多因素线性回归分析模型评价各影响因素的作用。结果40例患儿围手术期无死亡，无严重并发症发生。婴幼儿室间隔缺损合并重度肺动脉高压患者围手术期预后影响因素包括药物分组Group，x1，P=0．004，95％CI（-71，-16）]、TCPBx2，P=0．011，95％CI（0．9，5．8）]、术后PAPmx3，P=0．004，95％CI（3．2，13．3）]、术后RVSWIx4，P=0．003，95％CI（-16．9，-4．3）]和术后PVRIx5，P=0．03，95％CI（-0．29，-0．02）]。标准化回归系数的回归方程为：Y=-0．60x1＋0．54x2＋2．22x3-1．70x4-0．15x5。结论在婴幼儿室间隔缺损合并重度肺动脉高压围手术期临床监测指标中，是否应用PGE1脂质微球、TCPB、术后PAPm、术后RVSWI和术后PVRI与患儿的预后转归密切相关。

Analysis of Perioperative Prognostic Factors of Pediatric Patients Undergoing Surgical Correction of Ventricular Septal Defect and Severe Pulmonary Arterial Hypertension

Objective To analyze perioperative prognostic factors of pediatric patients undergoing surgical correction of ventricular septal defect （VSD） and severe pulmonary arterial hypertension （PAH）. Methods Forty pediatric patients with VSD and severe PAH （mean pulmonary artery pressure （PAPm） 〉 50 mm Hg） who underwent surgical repair in Beijing Anzhen Hospital from 2004 to 2012 were included in the study. There were 21 male and 19 female patients with their age of 7.2±3.3 years and body weight of 19.6±7.1 kg. All the patients were randomly divided into 2 groups： Group Ⅰ （Group= 0, n=20, M/F ： 12/8, continuous nitroglycerin administration via central venous catheter （CVC） and Group Ⅱ （Group=1, n=20, M/F： 9/11, continuous prostaglandin E1 （PGE1 ） administration via CVC ）. The duration of intubation （ Tintubation ） was used as the dependent variable （Y）. Patient age, cardiopulmonary bypass time （TCPB）, postoperative PAPm, pulmonary vascular resistance index （PVRI）, systemic to pulmonary pressure ratio （Ps/p）, Group, left ventricular stroke work index （LVSWI） and right ventricular stroke work index （RVSWI） were used as independent variables （X）. Multivariate liner regression analysis model was used to evaluate the influence of X on Y. Results There was no perioperative death or severe complication in this group. Perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH included group x1, P=0.004, 95% CI （-71, -16） ], TCPB x2, P=0.011, 95% CI （0.9, 5.8） 3, postoperative PAPm （x3, P=0.004 with 95% CI 3.2 to 13.3 ）, RVSWI （x4, P=0.003 with 95% CI-16.9 to-4.3 ） and PVRI （x5, P=- 0.03 with 95% CI-0.29 to-0.02 ）. The standardized regression equation was： Y=-0.60x1＋0.54x2 ＋ 2.22x3-1.70x4-0.15x5. Conelusion PGE1 administration, TCPB, postoperative PAPm, RVSWI and PVRI are predominant perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH.