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目的研究与法洛四联症(TOF)一期根治手术早期死亡相关的危险因素。方法回顾1995年4月至2004年3月在复旦大学附属儿科医院心血管中心行一期根治术的TOF病例152例,术后早期死亡17例,对其术前、术中27个可能的危险因素指标与术后早期死亡的关系进行单因素和多因素分析。结果单因素分析结果显示与术后早期死亡有关的指标包括手术时体重、发生青紫年龄、动脉血氧饱和度、升主动脉与肺动脉干直径比AO/MPA、McGoon比值、Nakata指数、肺体循环血流量之比Qp/Qs、右向左分流量占体循环血流量比例(QseQp)/Qs、体肺侧支循环和跨瓣补片。多因素分析结果显示AO/MPA和McGoon比值与手术早期死亡有关。结论肺动脉的发育情况是TOF一期根治术后能否生存的关键。手术病例的选择需要综合考虑多种危险因素。
Objective To study the risk factors associated with early death in the first phase of tetralogy of Fallot (TOF). Methods From April 1995 to March 2004, 152 patients with TOF underwent radical hysterectomy at the Cardiovascular Center of Pediatric Hospital Affiliated to Fudan University from April 1995 to March 2004 were retrospectively analyzed. There were 27 possible early deaths and 27 possible preoperative and postoperative complications Single factor and multivariate analysis of the relationship between factors and postoperative early death. Results The results of univariate analysis showed that the indexes related to early postoperative death included weight at surgery, age at onset of cyanosis, arterial oxygen saturation, AO / MPA, McGoon ratio, Nakata index, pulmonary circulation blood in ascending aorta to pulmonary artery Flow ratio Qp / Qs, right to left shunt volume flow rate (QseQp) / Qs, body lung collateral circulation and cross-valve patch. Multivariate analysis showed that AO / MPA and McGoon ratio were related to early surgical death. Conclusions The development of pulmonary artery is the key to survival after one-stage TOF. The choice of surgical cases need to consider a variety of risk factors.