儿童先天性心脏病术后低心排综合征的危险因素分析

向军; 何玲; 舒凯森; 刘艳; 彭慧; 彭泰峦; 魏蜀亮

doi:10.13201/j.issn.1001-1439.2020.06.013

儿童先天性心脏病术后低心排综合征的危险因素分析

- 1. 川北医学院附属医院心脏大血管外科(四川南充, 637000);
- 2. 川北医学院附属医院儿科;
- 3. 川北医学院药学院

详细信息

通讯作者: 魏蜀亮,E-mail:shuliang_wei@163.com

中图分类号: R541.1

收稿日期: 2020-02-25

修回日期: 2020-03-15

Analysis of risk factors for postoperative low cardiac output syndrome in children with congenital heart disease

- 1. Department of Cardio-Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China;
- 2. Department of Pediatrics, Affiliated Hospital of North Sichuan Medical College;
- 3. College of Pharmacy, North Sichuan Medical College

More Information

Corresponding author: WEI Shuliang, E-mail: shuliang_wei@163.com

Received Date: 25 February 2020

Revised Date: 15 March 2020

摘要

摘要: 目的：回顾性分析儿童先天性心脏病（CHD）术后低心排综合征（LCOS）的相关危险因素和并发症，探讨其LCOS的管理策略。方法：连续性收集2012年1月-2018年12月川北医学院附属医院心脏大血管外科收治的476例CHD患儿的临床资料，其中男性262例，女性214例；所有患儿均在全麻体外循环（CPB）下行心内畸形矫正术，按照术后是否发生LCOS分为LCOS组和非LCOS组，分别记录2组患儿术前、术中相关指标及术后并发症；将单因素分析具有统计学意义的变量进行多因素Logistic回归分析，进一步明确术后LCOS的危险因素；同时比较2组患儿并发症发生率及病死率。结果：儿童CHD术后LCOS发生率约为9.45%。多因素分析结果显示：年龄（OR=1.195，95%CI：1.019~3.254，P=0.024）、心室水平双向分流（OR=2.174，95%CI：1.251~6.812，P=0.021）、再次心脏手术（OR=2.015，95%CI：0.995~3.191，P=0.036）、主动脉阻断时间（OR=3.141，95%CI：1.579~5.454，P=0.010）、术后残余分流（OR=1.957，95%CI：1.102~3.836，P=0.017）是儿童CHD术后LCOS的独立危险因素。LCOS组患儿术后急性肝损伤（6.7%：0.7%，P=0.001）、急性肾损伤（13.3%：3.5%，P=0.011）、急性肺损伤（3.7%：1.2%，P=0.006）、肺部感染（31.1%：6.5%，P<0.001）发生率明显增高，机械通气时间[（32.1±36.8） h：（9.9±11.3） h，P<0.001]、ICU停留时间[（116.2±57.6） h：（41.6±22.4） h，P<0.001]、住院时间均明显延长[（16.5±8.3） d：（9.6±7.5） d，P<0.001]，围手术期病死率（17.8%：1.4%，P<0.001）明显增加。结论：年龄、心室水平双向分流、再次心脏手术、主动脉阻断时间、术后残余分流是儿童CHD术后LCOS的独立危险因素。LCOS与术后并发症发生率、病死率增加及住院时间延长显著相关。因此，应更加注重儿童CHD术后LCOS的危险因素，尽可能减少LCOS的发生以改善预后。
- 先天性心脏病 /
- 低心排综合征 /
- 危险因素 /
- 预后
Abstract: Objective: To analyze the independent risk factors and complications for postoperative low cardiac output syndrome (LCOS) in children with congenital heart disease (CHD) undergoing operation and investigate the management strategy of LCOS.Method: Between January 2012 to December 2018 from the department of cardio-vascular surgery, affiliated hospital of North Sichuan Medical College, 476 cases of children with CHD underwent operations were collected consecutively, 262 males and 214 females.All the children underwent operation by cardiopulmonary bypass (CPB) with general anesthesia.According to whether had LCOS, patients were divided into 2 groups:LCOS group and non-LCOS group.Univariate and logistic regression analyses were used to identify the independent risk factors.The perioperative complications were also recorded.Result: The incidence of LCOS in children with CHD was about 9.45%.The age (OR=1.195, 95%CI:1.019-3.254, P=0.024), ventricular horizontal bidirectional shunt (OR=2.174, 95%CI:1.251-6.812, P=0.021), reoperation (OR=2.015, 95%CI:0.995-3.191, P=0.036), aortic occlusion time (OR=3.141, 95%CI:1.579-5.454, P=0.010), and residual shunts (OR=1.957, 95%CI:1.102-3.836, P=0.017) were the independent risk factors of LCOS.The incidence rates of postoperative acute hepatic failure (6.7%:0.7%, P=0.001), acute kidney injury (13.3%:3.5%, P=0.011), acute lung injury (3.7%:1.2%, P=0.006) and lung infection (31.1%:6.5%, P<0.001) in LCOS group were significantly increased.The duration of mechanical ventilation[(32.1±36.8) h:(9.9±11.3) h, P<0.001] and ICU stay time[(116.2±57.6) h:(41.6±22.4) h, P<0.001] and hospitalization time[(16.5±8.3) d:(9.6±7.5) d, P<0.001] were significantly prolonged.The perioperative mortality (17.8%:1.4%, P<0.001) was significantly increased.Conclusion: The age, ventricular horizontal bidirectional shunt, reoperation, aortic occlusion time, residual shunts were the independent risk factors for postoperative LCOS in children with CHD.The perioperative complications in LCOS group were significantly increased.Therefore, more attention should be paid to the independent risk factors for postoperative LCOS in children with CHD, and minimize the occurrence of LCOS to improve the prognosis.
- congenital heart disease /
- low cardiac output syndrome /
- risk factors /
- prognosis

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参考文献(18)

[1]	Mishra TA, Sharma P.Health related quality of life of children with congenital heart disease attending at tertiary level hospital[J].J Nepal Health Res Counc, 2019, 17(3):288-292.
[2]	Cheng HH, Ferradal SL, Vyas R, et al.Abnormalities in cerebral hemodynamics and changes with surgical intervention in neonates with congenital heart disease[J].J Thorac Cardiovasc Surg, 2020, 159(5):2012-2021.
[3]	Chandler HK, Kirsch R.Management of the low cardiac output syndrome Following Surgery for Congenital Heart Disease[J].Curr Cardiol Rev, 2016, 12(2):107-111.
[4]	Nordness MJ, Westrick AC, Chen H, et al.Identification of low cardiac output syndrome at the bedside:a pediatric cardiac intensive care unit survey[J].Crit Care Nurse, 2019, 39(2):e1-e7.
[5]	Pérez Vela JL, Jiménez Rivera JJ, Alcalá Llorente MÁ, et al.Low cardiac output syndrome in the postoperative period of cardiac surgery.Profile, differences in clinical course and prognosis.The ESBAGA study[J].Med Intensiva, 2018, 42(3):159-167.
[6]	Alten JA, Gaies M.Defining low cardiac output syndrome:an ode to justice potter stewart[J].Pediatr Crit Care Med, 2017, 18(1):85-87.
[7]	Kato H, Matsui Y.Perioperative care of low cardiac output syndrome[J].Kyobu Geka, 2017, 70(8):565-570.
[8]	Hickok RL, Spaeder MC, Berger JT, et al.Postoperative abdominal NIRS values predict low cardiac output syndrome in neonates[J].World J Pediatr Congenit Heart Surg, 2016, 7(2):180-184.
[9]	Lomivorotov VV, Efremov SM, Kirov MY, et al.Low cardiac output syndrome after cardiac surgery[J].J Cardiothorac Vasc Anesth, 2017, 31(1):291-308.
[10]	Ulate KP, Yanay O, Jeffries H.et al.An elevated low cardiac output syndrome score is associated with morbidity in infants after congenital heart surgery[J].Pediatr Crit Care Med, 2017, 18(1):26-33.
[11]	Avila-Alvarez A, Del Cerro Marin MJ, Bautista-Hernandez V.Pulmonary vasodilators in the management of low cardiac output syndrome after pediatric cardiac surgery[J].Curr Vasc Pharmacol, 2016, 14(1):37-47.
[12]	Seth HS, Mishra P, Khandekar JV, et al.Relationship between high red cell distribution width and systemic inflammatory response syndrome after extracorporeal circulation[J].Braz J Cardiovasc Surg, 2017, 32(4):288-294.
[13]	Farag M, Veres G, Szabó G, et al.Hyperbilirubinaemia after cardiac surgery:the point of no return[J].ESC Heart Failure, 2019, 6(4):694-700.
[14]	Hickok RL, Spaeder MC, Berger JT, et al.Postoperative abdominal NIRS values predict low cardiac output syndrome in neonates[J].World J Pediatr Congenit Heart Surg, 2016, 7(2):180-184.
[15]	Jacobs JP, Mavroudis C, Quintessenza JA, et al.Reoperations for pediatric and congenital heart disease:an analysis of the Society of Thoracic Surgeons(STS) congenital heart surgery database[J] Semin Thorac Surg Pediatr Card Surg Annu, 2014, 17(1):2-8.
[16]	Hummel J, Rücker G, Stiller B.Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease[J].Cochrane Database Syst Rev, 2017, 8:CD011312.
[17]	Sá MP, Nogueira JR, Ferraz PE, et al.Risk factors for low cardiac output syndrome after coronary artery bypass grafting surgery[J].Rev Bras Cir Cardiovasc, 2012, 27(2):217-223.
[18]	汪学文, 刘娟珠, 冯褀论, 等.左西孟旦对心脏手术患者生存及预后影响的Meta分析[J].临床心血管病杂志, 2018, 34(3):276-282.