摘要
目的：判定５岁以下患儿法乐四联症根治术后早期死亡或出现灌注肺及严重低心输出量综合征的危险因素。方法：将３个月至５岁的３６０例法乐四联症根治术患儿的２１个术前及术中因素与手术结果进行了单因素和多因素分析，将其中接受心血管造影检查的３２例患儿的术前肺血管和左心室发育情况与手术结果进行了相关性分析。结果：单因素分析结果：手术时年龄小（＜１０个月），体重轻（＜８ｋｇ），血红蛋白低（＜１５０ｇ／Ｌ），体外循环期间低流量时间与低温时间比值大（＞０．８）、预充液晶体与胶体比值高（＞１），体外循环时间长（＞１００分钟），应用同种带瓣血管片，与手术后早期死亡或发生灌注肺和严重的低心输出量综合征有关（Ｐ＜０．０５）。多因素分析结果：手术时体重小、体外循环时低流量时间与低温时间比值大、预充液晶体与胶体比值高及体外循环时间长与手术后早期死亡或发生灌注肺和严重的低心输出量综合征有关（Ｐ＜０．０５）。结论：法乐四联症根治术的手术适应证可适当放宽，对重症患儿要加强围手术期的处理。
? Objective:To determine the risk factors of early postoperative death or ARDS (acute respiratory distress syndrome) and serious low cardiac output syndrome associated with the total correction of tetralogy of Fallot. Methods:We analyzed 21 clinical variables of 360 patients aged 3 months to 5 years in a univariate and multivariate manner and the correlation between preoperative size of pulmonary artery and left ventricular volume in 32(9.16%)severe patients with cardiac catheterization and postoperative out comes. Results:Univariate analysis showed that patients of low age(<10 Mo),low weight(<8 kg),low Hb(<150 g/L) at the time of operation,higher ratio of the time of low flow cardiopulmonary bypass(CPB)to the time of hypothermia(>0.8) and higher ratio of crystal to colloid(>1) during CPB,longer time of CPB(>100 min),and using homograft patch(with valve)were associated with worse outcome(p<0.05).While multivariate analysis showed that patients of low weight,higher ratio of the time of low flow CPB to the time of hypothermia,higher ratio of crystal to colloid during CPB,and longer time of CPB were associated with worse outcome(p<0.05). Conclusion:The indcations for total correction of tetralogy of Fallot might be extended.However,we should pay attention to the patients who have the high risk factors of early postoperative death or ARDS and serious low cardiac output syndrome.
出处
《中国循环杂志》
CSCD
北大核心
1997年第6期403-406,共4页
Chinese Circulation Journal
