3岁以下患儿法洛四联症根治术影响早期效果的危险因素

目的 :分析影响 3岁以下法洛四联症 (TOF)根治术早期效果的危险因素 ,重点探讨婴幼儿TOF根治术的手术时机和适应证。方法 :分析 3岁以下TOF根治术 4 17例的早期效果 ,其中男性 2 98例 ,女性 119例 ,年龄 3个月～ 3岁。术后早期恶性事件和不良事件指早期死亡和重症监护 (ICU)时间 >7d。统计学分析 ,影响早期效果的临床危险因素。结果 :单因素分析结果显示 :影响术后早期效果的危险因素包括年龄 <1岁 (17/ 5 4例VS 5 6 / 36 3例 ,P <0 0 5 ) ,术后右心室 /左心室收缩压比值 >0 75 (2 0 / 2 7例VS5 3/ 390例 ,P <0 0 5 ) ,预充液白蛋白浓度 >10 % (4 / 39例VS 6 9/ 378例 ,P <0 0 5 ) ,应用改良超滤 (4 / 39例VS 6 9/ 378例 ,P <0 0 5 ) ,严重低心排出量综合征 (2 4 / 33例VS 4 9/ 384例 ,P <0 0 5 ) ,呼吸道并发症 (33/ 4 2例VS 4 0 / 375例 ,P <0 0 5 )。多因素logistic逐步回归分析 :年龄 <1岁 ,术后右心室 /左心室收缩压比值>0 75 ,呼吸道并发症是影响术后早期效果的危险因素。结论 :深入研究婴幼儿TOF的病理生理特点 ,提高手术技术 ,3岁以下TOF根治术的效果是满意的。

Risk factors affecting the early postoperative outcome in patients under 3 ydars old after repair of tetralogy of Fallot

Objective:To analyze the risk factors affecting early postoperative outcome for correction of tetralogy of Fallot(TOF) in the patients under 3 years old.Method:We analyzed 22 perioperative valiables in 417 patients underwent the correction of TOF and identified the risk factors affecting the early outcome.The early postoperative bad accidents include early postoperative death and ICU stay over seven days after operation.Result:Age less than 1 year old,right ventricular/left ventricular postoperative pressure ratio over 0.75,albumin concentration in primiing fluid over 10%,usage of modified ultrafilteration,severe low cardiac output syndrome,postoperative respiratory system complications were risk factors affecting the early postoperative outcome by univariate analysis.Age less than 1 year old,right ventricular/left ventricular postoperative pressure ratio over 0.75 and postoperative complications of respiratory system were related with the early postoperative outcome by multiple logistic discriminant analysis.Conclusion:With deep understanding of the pathological change of TOF in infant and modification of surgical skill,the results of correction of TOF in the patients under 3 years old are satisfactory.