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目的：判定５岁以下患儿法乐四联症根治术后早期死亡或出现灌注肺及严重低心输出量综合征的危险因素。方法：将３个月至５岁的３６０例法乐四联症根治术患儿的２１个术前及术中因素与手术结果进行了单因素和多因素分析，将其中接受心血管造影检查的３２例患儿的术前肺血管和左心室发育情况与手术结果进行了相关性分析。结果：单因素分析结果：手术时年龄小（＜１０个月），体重轻（＜８ｋｇ），血红蛋白低（＜１５０ｇ／Ｌ），体外循环期间低流量时间与低温时间比值大（＞０．８）、预充液晶体与胶体比值高（＞１），体外循环时间长（＞１００分钟），应用同种带瓣血管片，与手术后早期死亡或发生灌注肺和严重的低心输出量综合征有关（Ｐ＜０．０５）。多因素分析结果：手术时体重小、体外循环时低流量时间与低温时间比值大、预充液晶体与胶体比值高及体外循环时间长与手术后早期死亡或发生灌注肺和严重的低心输出量综合征有关（Ｐ＜０．０５）。结论：法乐四联症根治术的手术适应证可适当放宽，对重症患儿要加强围手术期的处理。
OBJECTIVE: To determine the risk factors of early death after death in patients with tetralogy of Fallot under 5 years of age or with perfusion of lung and severe low cardiac output syndrome. METHODS: Twenty-one preoperative and intraoperative factors and surgical outcomes in 360 children undergoing tetralogy of Fallot from 3 months to 5 years of age were analyzed by univariate and multivariate analyzes, and those undergoing cardiovascular angiography Preoperative pulmonary vascular and left ventricular development in 32 children were analyzed with correlation with surgical findings. Results: The results of univariate analysis showed that when the operation was young (<10 months), light weight (<8kg), hemoglobin was low (<150g / L) and the ratio of low flow time to low temperature time during cardiopulmonary bypass ), Prefilled liquid to gel ratio (> 1), long cardiopulmonary bypass (> 100 minutes), the use of allogeneic valved vasculature slices, and early death after surgery or perfusion of lungs and severe low cardiac output combined Sign related (P <0.05). Multivariate analysis showed that the body weight was small at surgery, the ratio of low-flow time to low-temperature time during cardiopulmonary bypass was large, the ratio of prefilled liquid to colloid was high, the length of cardiopulmonary bypass was long, and the death or perfusion of lung occurred early after surgery and severe low cardiac output Volume syndrome (P <0.05). Conclusion: The surgical indications of tetralogy of Fallot can be appropriately relaxed, and the perioperative management should be strengthened for children with severe tetralogy of Fallot.