摘要
目的分析儿童室间隔缺损采用改良修补术后早、中期疗效。并对术后并发心律失常的因素进行分析,并构建风险预测模型。方法收集徐州市儿童医院2022年10月至2023年10月收治的儿童间隔缺损患儿100例临床资料,患儿均进行改良修补术治疗。观察患儿围术期各指标、术前术后心功能情况。并对患儿术后发生心律失常及未发生者各项参数指标进行分析,采用受试者工作特征曲线(receiver operator characteristic curve,ROC曲线)绘制心律失常的预测模型。结果术后1个月、3个月时患儿左心室舒张末径、肺动脉内径、肺动脉瓣血流速度明显低于术前;主动脉瓣口血流速度明显高于术前(P<0.05)。100例行改良修补术患儿共15例(15.00%)发生术后心律失常、85例(85.00%)未发生;对两类患儿进行分组观察临床各项参数显示,年龄、采用修补类型、修补直径、术前心律失常、手术时间、术前肺动脉内径、术前肺动脉瓣血流速度是导致心律失常发生的可疑影响因素(P<0.05)。进一步logistic回归分析显示,年龄、手术修补类型、修补直径、术前心律失常、手术时间是导致术后并发心律失常的主要影响因素(P<0.05)。根据回归系数拟合所得出的联合数据进行ROC分析显示,联合预测模型的预测AUC为0.980;预测敏感度93.3%、特异度98.8%。结论儿童室间隔缺损患儿采用改良修补术后,心功能恢复较佳。术后早中期并发心律失常的主要因素包括年龄、手术修补类型、修补直径、术前心律失常、手术时间;临床对此要予以重视。
Objective To explore the early and mid-term effects of the improved repair of ventricular septal defect in children and the factors of postoperative arrhythmia and to establish a risk prediction model.Methods The clinical data of 100 children with septal defect admitted to Xuzhou Children’s Hospital and treated with the improved repair from October 2022 to October 2023 were collected.The perioperative indexes and cardiac function before and after the operation were observed.The parameters of postoperative arrhythmia and non arrhythmia were analyzed.The receiver operating characteristic curve(ROC curve)was used to draw the prediction model of arrhythmia.Results At 1 month and 3 months after the operation,the left ventricular end diastolic diameter,pulmonary artery diameter and pulmonary valve blood flow velocity were significantly lower than those before the operation.The aortic orifice blood flow velocity was significantly higher than that before the operation(P<0.05).Among the 100 children,15 cases(15.00%)developed postoperative arrhythmia.The clinical parameters of the two groups showed that the age,repair type,repair diameter,preoperative arrhythmia,operation time,preoperative pulmonary artery diameter and preoperative pulmonary valve blood flow velocity were the suspicious influencing factors(P<0.05).Further logistic regression analysis showed that the age,surgical repair type,repair diameter,preoperative arrhythmia and operation time were the main factors leading to postoperative arrhythmia(P<0.05).According to the joint data obtained by regression coefficient fitting,ROC analysis showed that the prediction AUC of the joint prediction model was 0.980 and the sensitivity and specificity of prediction were 93.3%and 98.8%respectively.Conclusion After the improved repair of ventricular septal defect in children,the cardiac function recovered better.The main factors of early and middle postoperative arrhythmia include the age,surgical repair type,repair diameter,preoperative arrhythmia and operation time,which
作者
李迎
刘建国
张德云
何飞
李青
LI Ying;LIU Jian-guo;ZHANG De-yun;HE Fei;LI Qing(Department of Cardiothoracic Surgery,Xuzhou Children’s Hospital,Xuzhou 221000,China)
出处
《中国心血管病研究》
CAS
2024年第4期336-340,共5页
Chinese Journal of Cardiovascular Research
基金
徐州市儿童医院科研立项(22040424)。
关键词
儿童室间隔缺损
改良修补术
早中期
疗效
心律失常
预测模型
Ventricular septal defect in children
Improved repair
Early and middle period
Therapeutic effect
Arrhythmia
Prediction mode
