3个月内复杂先天性心脏病患儿术后延迟关胸的因素分析

目的 探讨3个月内的复杂先天性心脏病患儿术后行延迟关胸的危险因素.方法 2000年1月～2006年10月收治119例胸骨正中切口并进行体外循环的患儿,男97例,女22例,年～龄1～90 d,平均(44±26)d,体重2.2～7.1 kg,平均(3.9±0.9)kg,分析年龄、性别、体重、术前胸围、诊断、是否为早产儿、术前是否机械通气、SpO2、胸片测得的心胸比例、心超测得的左心射血分数、体外循环时间、主动脉阻断时间、深低温停循环等因素与延迟关胸的相关性.结果 延迟关胸47例,占39.5%,主动脉弓离断或完全性肺静脉异位引流(心下型)或TGA/VSD的延迟关胸的比例高(延迟关胸率＞75%),单因素分析结果:年龄、体重、胸围、术前机械通气、体外循环时间、主动脉阻断时间、深低温停循环差异有统计学意义,Logistic回归分析发现:年龄、术前机械通气、体外循环时间、深低温停循环是独立的相关因素.结论 延迟关胸对于复杂先天性心脏病患儿来说是一种简单、安全、有效的手术技术,延迟关胸与主动脉弓离断或完全性肺静脉异位引流(心下型)或TGA/VSD有关,低年龄、术前机械通气、长时间体外循环、深低温停循环是延迟关胸的危险因素.

Predictive risk factors for delayed sternal closure in the patients under the age of three months old with congenital cardiac disease

Objective To analyze the risk factors related with delayed sternal closure(DSC)in the patients under three months old with complex cardiac disease.Methods One hundred and nineteen patients underwent median sternotomy and cardiopulmonary bypass(CPB)between Jan 2000 to Oct 2006.The age ranged from 1 to 90 days(mean 44±26 days)and the weight ranged from 2.2 kg to 7.1 kg(mean 3.9±0.89 kg).SPSS v 11.5 software was used to analyze the factors including the age,gender,weight,preoperative conditions,diagnose,prematurity,requirement for preoperative mechanic ventilation,preoperative SPO2,cardia-thoracic area ratio,left ventricular faction,CPB duration,clamping time,total circulatory arrest with profound hypothermia.Results Forty-seven patients had DSC.The rate of DSC iS over 75% for IAA or TAPVD(infracardiac)or TGA/VSD.The risk factors including age(P=0.032),pre-operative mechanic ventilation(P=0.001),CPB duration(P=0.000),total circulatory arrest with profound hypothermia(P=0.001).They were statistically significant(multivariate logistic regression).Conclusions DSC is a simple,safe and efficient procedure for the complex cardiac diseases.DSC iS related to IAA or TAPVD(infracardiac)or TGA/VSD.Age,pre-operative mechanic ventilation,CPB duration,total circulatory arrest with profound hypothermia are the risk factors for DSC.Understanding the factors iS helpful in the clinical decision making process.