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目的探讨婴幼儿室间隔缺损合并重度肺动脉高压患者围手术期预后的影响因素,为此类患者的预后判断提供参考。方法选取2004~2012年北京安贞医院40例室间隔缺损合并重度肺动脉高压(PAPm>50 mm Hg)的手术治疗患儿,男21例、女19例,年龄(7.2±3.3)岁,体重(19.6±7.1)kg。入选患儿随机分成两组:组Ⅰ(Group=0,n=20,男/女:12/8)经中心静脉持续泵入硝酸甘油;组Ⅱ(Group=1,n=20,男/女:9/11),经中心静脉持续泵入前列腺素E1(PGEl)脂质微球。以气管内插管时间(Tintubation)为因变量(Y),以患者年龄(Age)、体外循环时间(TCPB)、术后平均肺动脉压(PAPm)、术后肺血管阻力指数(PVRI)、术后体循环压力/肺循环压力(Ps/p)、用药分组(Group)、术后左心室每搏功指数(LVSWI)和术后右心室每搏功指数(RVSWI)为自变量(X),采用多因素线性回归分析模型评价各影响因素的作用。结果 40例患儿围手术期无死亡,无严重并发症发生。婴幼儿室间隔缺损合并重度肺动脉高压患者围手术期预后影响因素包括药物分组[Group,x1,P=0.004,95%CI(-71,-16)]、TCPB[x2,P=0.011,95%CI(0.9,5.8)]、术后PAPm[x3,P=0.004,95%CI(3.2,13.3)]、术后RVSWI[x4,P=0.003,95%CI(-16.9,-4.3)]和术后PVRI[x5,P=0.03,95%CI(-0.29,-0.02)]。标准化回归系数的回归方程为:Y=-0.60x1+0.54x2+2.22x3-1.70x4-0.15x5。结论在婴幼儿室间隔缺损合并重度肺动脉高压围手术期临床监测指标中,是否应用PGEl脂质微球、TCPB、术后PAPm、术后RVSWI和术后PVRI与患儿的预后转归密切相关。
Objective To investigate the influencing factors of perioperative prognosis in patients with ventricular septal defect and severe pulmonary hypertension in infants and young children and provide reference for the prognosis of these patients. Methods Forty children (21 males and 19 females) with ventricular septal defect complicated with severe pulmonary hypertension (PAPm> 50 mm Hg) from 2004 to 2012 in Beijing Anzhen Hospital were selected and their ages (7.2 ± 3.3) years, body weight 19.6 ± 7.1) kg. The children were randomly divided into two groups: Group Ⅰ (Group = 0, n = 20, male / female: 12/8) : 9/11), PGEl lipid microspheres were continuously pumped through the central vein. Tintubation was used as the dependent variable (Y), and the age, duration of postoperative cardiopulmonary bypass (TCPB), postoperative mean pulmonary arterial pressure (PAPm), postoperative pulmonary vascular resistance index (PVRI) Ps / p, Group, postoperative left ventricular stroke volume index (LVSWI) and right ventricular stroke power index (RVSWI) as independent variable (X) Factors linear regression analysis model evaluation of the impact of various factors. Results 40 cases of children perioperative death without serious complications. The influencing factors of perioperative prognosis of infantile ventricular septal defect with severe pulmonary hypertension include grouping of drugs [Group, x1, P = 0.004, 95% CI (-71, -16)], TCPB Postoperative PAPS [x3, P = 0.004, 95% CI (3.2,13.3)], postoperative RVSWI [x4, P = 0.003,95% CI (-16.9, -4.3)] and Postoperative PVRI [x5, P = 0.03, 95% CI (-0.29, -0.02)]. The regression equation of standardized regression coefficients is: Y = -0.60x1 + 0.54x2 + 2.22x3-1.70x4-0.15x5. Conclusion The prognosis of children with infantile ventricular septal defect complicated with severe pulmonary hypertension in the clinical monitoring indicators, the use of PGEl lipid microspheres, TCPB, postoperative PAPm, postoperative RVSWI and postoperative PVRI prognosis are closely related.