摘要
目的探讨婴儿期外科治疗完全性肺静脉异位连接(total anomalous pulmonary venous connection,TAPVC)的风险因素,分析不同类型TAPVC外科治疗随访结果的差异。方法总结广州市妇女儿童医疗中心2009年1月至2019年12月婴儿期手术治疗的TAPVC患儿的资料,同时对这些患儿进行随访。将术前有关因素与住院手术死亡进行单因素相关性分析和多因素相关性分析;将全部患儿按TAPVC的类型分组,分别用Kaplan-Meier法生成术后各组的近-中期生存曲线,并对这些生存曲线用log-rank法进行总体差异性检验,同时对各组间的差异性进行检验。结果手术患儿246例,手术死亡16例,手术病死率为6.50%。心内型、心上型、心下型、混合型分别为91例、106例、34例、15例,分别手术死亡2例、5例、6例、3例,病死率分别2.20%、4.72%、17.65%、20.00%。单因素分析显示与手术死亡有相关性的因子有TAPVC类型、术前休克/酸中毒、体外循环时间、主动脉阻断时间、手术过程中有深低温停循环;多因素分析显示与手术死亡有相关性的因子有TAPVC类型、术前休克/酸中毒、体外循环时间、主动脉阻断时间、手术过程中有深低温停循环、手术时低体质量。全部手术存活患儿随访死亡19例,用Kaplan-Meier法生成生存曲线,术后1年、3年、6年、9年总体累积生存率分别为89%、86%、85%、85%。随访死亡患儿中,心上型、心内型、心下型、混合型分别为6、5、8、0例。各组术后1年、3年、6年、9年累积生存率分别为心内型92%、92%、92%、92%;心上型93%、90%、89%、89%;心下型70%、54%、54%、54%;混合型80%、80%、80%、80%。术后各组生存曲线比较,差异有统计学意义(P<0.05):心下型术后累计生存率显著低于心内型和心上型。结论婴儿期TAPVC的外科治疗独立风险因子有TAPVC类型、术前休克/酸中毒、体外循环时间、主动脉阻断时间、手术过程中有深低温停循环�
Objectives To analyze the risk factors of operative mortality of total anomalous pulmonary venous connection(TAPVC)in infants;to analyze the survival difference of the infants after the correction of TAPVC.Methods Clinical data of infants with TAPVC after operation in Guangzhou Women and Children′s Hospital during January 2009 and December 2019 were retrospectively analyzed.The outcomes of the follow-up of these infants were also analyzed.The single factor correlation between the operative mortality and the potential risk factors of the operation were analyzed,and then the multiple factors correlations between the mortality and the potential risk factors were analyzed.All the infants were grouped according to the type of TAPVC.The short to mid-term survival curves of the groups after operation were drawn by Kaplan-Meier method and the overall differences of these survival curves were analyzed by log-rank method.The diferences of the groups were compared.Results Totally 246 infants operation with TAPVC were finished,among them,16 infants with operative mortality(6.5%).There were 91,106,34 and 15 infants with cardiac type,supracardiac type,infracardiac type and mixed type,respectively;and there were 2(2.20%),5(4.72%),6(17.65%)and 3(20.0%)infants with operative mortality.These factors proved significantly correlated with operative mortality in single correlation analysis:the type of TAPVC,shock/acidosis before operation,duration of cardiopulmonary bypass(CPB),duration of cardiac arrest,deep hypothermia circulatory arrest(DHCA).Logistic regression demonstrated that the type of TAPVC,shock/acidosis before operation,duration of CPB,duration of cardiac arrest,DHCA,low-weight at operation were the in⁃dependent risk factors of the operation.Among all the survival infants,19 infants died in the process of follow-up:6,5,8,0 infants in cardiac type,supracardiac type,infracardiac type and mixed type,respectively.Kaplan-Meier survival curve indicated that the cumulative survival rate was 89%,86%,85%,85%of 1 year,3 years,6
作者
杨盛春
陈欣欣
马力
邹明晖
陈伟丹
夏园生
李文雷
杨海燕
YANG Shengchun;CHEN Xinxin;MA Li;ZOU Minghui;CHEN Weidan;XIA Yuansheng;LI Wenlei;YANG Haiyan(Heart Center,Guangzhou Women and Children′s Hospital,Guangzhou 510623,China;Guangzhou Red Cross Hospital,Guangzhou 510235,China)
出处
《岭南心血管病杂志》
CAS
2023年第4期385-390,共6页
South China Journal of Cardiovascular Diseases
关键词
先天性心脏病
完全性肺静脉异位连接
婴儿
危险因素
心脏外科手术
congenital heart defects
total anomalous pulmonary venous connection
infant
risk factor
cardiac surgical procedure
