2024 年第 6 期 第 0 卷

儿童法洛四联症根治术后延迟拔管的危险因素分析

Risk factors for delayed extubation after radical surgery in children with tetralogy of Fallot

作者：朱燕樊星张汀洲顾虹贺彦

英文作者：Zhu Yan Fan Xing Zhang Tingzhou Gu Hong He Yan

单位：首都医科大学附属北京安贞医院小儿心脏中心北京市心肺血管疾病研究所，北京100029

英文单位：Pediatric Heart Center Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：法洛四联症；机械通气；延迟拔管；危险因素

英文关键词：TetralogyofFallot;Mechanicalventilation;Delayedextubation;Riskfactors

• 摘要：

• 目的 分析法洛四联症(TOF)患儿根治术后延迟拔管的危险因素。方法 入选2018年1月至2021年12月在首都医科大学附属北京安贞医院小儿心脏中心确诊为TOF的287例患儿作为研究对象，按机械通气时间是否≥49 h(中位数)分为正常拔管组(144例)和延迟拔管组(143例)。收集2组病例围手术期临床资料行对比分析，探索影响机械通气时间的单因素变量，再行多因素Logistic回归分析。结果 所有患儿均接受根治手术，机械通气时间49(24,93)h。2组患儿的年龄、体重、体表面积、术前脉搏血氧饱和度、Mcgoon比值、超声测得肺动脉指数、术前侧支封堵比例、跨瓣环补片手术比例、体外循环时间、升主动脉阻断时间、重症监护病房住院时间、术后毛细血管渗漏综合征(CLS)发生率、术后严重不良事件发生率比较差异均有统计学意义(均P＜0.05)。多因素Logistic回归分析结果显示，术前行侧支封堵（比值比=2.896）、术后出现CLS（比值比=6.610）、行跨环补片根治术（比值比=1.800）、体重较小(比值比=0.959）均是TOF患儿术后延迟拔管的独立危险因素（均P＜0.05）。结论 术前行侧支封堵、术后出现CLS、行跨环补片根治术、体重较小是TOF患儿术后延迟拔管的独立危险因素。

• Objective To analyze the risk factors for delayed extubation after radical surgery in children with tetralogy of Fallot (TOF). Methods A total of 287 children diagnosed with TOF in the Pediatric Heart Center, Beijing Anzhen Hospital, Capital Medical University from January 2018 to December 2021 were enrolled in this study. Based on whether mechanical ventilation time was greater than or equal the median (49 h), they were divided into normal extubation group (144 cases) and delayed extubation group (143 cases). The perioperative clinical data of the two groups were collected for comparative analysis, to explore the single factor affecting the duration of mechanical ventilation, and then multivariate Logistic regression analysis was performed. Results All children underwent radical surgery, and the median mechanical ventilation time was 49(24,93)h. The age, body mass, body surface area, preoperative blood oxygen saturation, Mcgoon ratio, pulmonary artery index measured by ultrasound, proportion of preoperative lateral branch occlusion, proportion of cross valve ring patch surgery, cardiopulmonary bypass time, ascending aorta occlusion time, length of intensive care unit hospital stay, proportion of postoperative capillary leakage syndrome (CLS), and the proportion of serious adverse events in two groups after surgery showed statistically significant differences (all P＜0.05). Multivariate Logistic regression analysis showed that preoperative lateral branch occlusion (odds ratio=2.896), postoperative CLS(odds ratio=6.610), cross valve ring patch surgery (odds ratio=1.800), and lower body mass(odds ratio=0.959) were independent risk factors for postoperative delayed extubation in children with TOF（all P＜0.05）. Conclusion Preoperative lateral branch occlusion, postoperative CLS, cross valve ring patch surgery and lower body mass are independent risk factors for postoperative delayed extubation in children with TOF.