目的:明确影响室间隔缺损患儿术后恢复的危险因素,在临床上为促进室间隔缺损术后患儿快速恢复提供参考策略。方法:通过医院层面调查研究,对于2018年7月8日至2021年3月1日在青岛市妇女儿童医院就诊并实施室间隔缺损开胸手术的患儿进行基本信息、手术信息及住院信息的收集并整理。采用单因素分析和非条件Logistic回归分析对影响室间隔缺损术后恢复的相关因素进行统计学分析。结果:单因素分析结果显示手术路径是影响室间隔缺损的因素。非条件Logistic回归分析结果显示,室间隔缺损类型为膜周型(OR: 0.395; 95%CI: 0.155~0.999);手术路径为右侧腋下切口(OR: 0.054; 95%CI: 0.005~0.587)是影响室间隔缺损患儿术后恢复的保护因素。结论:室间隔缺损类型为膜周型、手术路径为右侧腋下切口会降低患室间隔缺损患儿术后恢复的风险,有利于对患儿进行术前评估,为临床术前工作的实施提供参考策略。 Objection: To identify the risk factors that affect the recovery after surgery for ventricular septal defect, and provide intervention strategy for the clinic. Methods: The study method was conducted to collect the information of children with ventricular septal defect from August 1, 2018 to April 30, 2019. The information includes basic information, surgical information, and hospitalization information. A logistic regression model was applied to assess the association between CHD and possible risk factors. Univariate analyses and unconditional logistic regression analysis were performed to assess the association between the recovery after surgery for ventricular septal defect and possible risk factors. Results: The result of univariate analyses indicated that surgical path was the factor of affecting the recovery after surgery for ventricular septal defect. Results from Logistic regression model indicated that, perimembranous ventricular septal defect (odds ratio, (OR): 0.395; 95% confidence interval, (CI): 0.155~0.999), right vertical infraaxillary thoracotomy (OR: 0.054; 95%CI: 0.005~0.587) were negatively associated with the recovery after surgery for ventricular septal defect. Conclusion: Perimembranous ventricular septal defect and right vertical infraaxillary thoracotomy could reduce the risk of recovery surgery for ventricular septal defect. Our findings are benefit to preoperative evaluation for patients and provide a reference strategy.
目的:明确影响室间隔缺损患儿术后恢复的危险因素,在临床上为促进室间隔缺损术后患儿快速恢复提供参考策略。方法:通过医院层面调查研究,对于2018年7月8日至2021年3月1日在青岛市妇女儿童医院就诊并实施室间隔缺损开胸手术的患儿进行基本信息、手术信息及住院信息的收集并整理。采用单因素分析和非条件Logistic回归分析对影响室间隔缺损术后恢复的相关因素进行统计学分析。结果:单因素分析结果显示手术路径是影响室间隔缺损的因素。非条件Logistic回归分析结果显示,室间隔缺损类型为膜周型(OR: 0.395; 95%CI: 0.155~0.999);手术路径为右侧腋下切口(OR: 0.054; 95%CI: 0.005~0.587)是影响室间隔缺损患儿术后恢复的保护因素。结论:室间隔缺损类型为膜周型、手术路径为右侧腋下切口会降低患室间隔缺损患儿术后恢复的风险,有利于对患儿进行术前评估,为临床术前工作的实施提供参考策略。
室间隔缺损,危险因素,外科手术
Xiao Jin
Qingdao University, Qingdao Shandong
Received: Mar. 12th, 2021; accepted: Apr. 7th, 2021; published: Apr. 15th, 2021
Objection: To identify the risk factors that affect the recovery after surgery for ventricular septal defect, and provide intervention strategy for the clinic. Methods: The study method was conducted to collect the information of children with ventricular septal defect from August 1, 2018 to April 30, 2019. The information includes basic information, surgical information, and hospitalization information. A logistic regression model was applied to assess the association between CHD and possible risk factors. Univariate analyses and unconditional logistic regression analysis were performed to assess the association between the recovery after surgery for ventricular septal defect and possible risk factors. Results: The result of univariate analyses indicated that surgical path was the factor of affecting the recovery after surgery for ventricular septal defect. Results from Logistic regression model indicated that, perimembranous ventricular septal defect (odds ratio, (OR): 0.395; 95% confidence interval, (CI): 0.155~0.999), right vertical infraaxillary thoracotomy (OR: 0.054; 95%CI: 0.005~0.587) were negatively associated with the recovery after surgery for ventricular septal defect. Conclusion: Perimembranous ventricular septal defect and right vertical infraaxillary thoracotomy could reduce the risk of recovery surgery for ventricular septal defect. Our findings are benefit to preoperative evaluation for patients and provide a reference strategy.
Keywords:Ventricular Septal Defect, Risk Factor, Surgery
Copyright © 2021 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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先天性心脏病是指胚胎时期心和大血管发育异常,又称先天性心脏畸形 [
早年,Bandla Hari PR MD等通过回顾性病例分析指出肺部并发症,尤其是中央气道问题,是导致幼儿心脏手术后恢复迟缓的常见原因 [
于2018年7月8日至2021年3月1日在青岛市妇女儿童医院诊断为室间隔缺损并进行开胸手术治疗患儿,将其分别两组:术后住院时间 ≤ 10天,术后住院时间 > 10天。
对2018年7月8日至2021年3月1日在青岛市妇女儿童医院诊断为室间隔缺损并进行开胸手术治疗患儿进行数据收集。当患儿收入院后由医护人员对患儿基本信息及病史的采集,随着治疗的推进进一步完善患儿手术信息及住院信息,并将所有信息录入数据库。
室间隔缺损通常定义为左右心室之间存在异常交通,引起心室内左向右分流,产生血流动力学紊乱 [
同时患有室间隔缺损和其他心脏畸形的患儿。
为了最大程度地减少不同手术医师之间的偏倚,所有手术均为青岛市妇女儿童医院同一个医疗团队所实施。
使用EpiData3.1建立数据库,所有信息采用双人双录入并进行整理和核对,连续变量和分类变量分别用为平均值(标准偏差,SD)或中位数(四分位间距,IQR)表示。为明确影响室间隔缺损患儿术后恢复的独立因素,分别进行两个独立样本t检验、卡方检验或Fisher检验和多因素分析。首先在术后住院时间较短组和术后住院时间较长组之间对患儿BMI、年龄、出生体重、性别、是否足月、室间隔缺损类型、是否合并肺动脉高压、是否合并其他系统畸形、手术方式、手术路径、手术时长、体外循环时长、主动脉阻断时长等13个危险因素进行两个独立样本t检验、卡方检验或Fisher检验,结合分析结果及临床意义,建立多因素Logistic回归模型,确定影响影响室间隔缺损患儿术后恢复的独立因素。独立因素与患儿室间隔缺损术后恢复时长之间的关联通过相对风险(OR)进行量化,P值小于0.05 (两端)被认为具有统计学意义。
该研究共纳入106例室间隔缺损患儿,且均进行开胸手术。本研究室间隔缺损患儿BMI平均值为(16.05 ± 4.64) kg/m2,其中术后住院时间较短组为(15.82 ± 3.72) kg/m2,术后住院时间较长组为(16.44 ± 2.81) kg/m2,无统计学差异(P = 0.373);平均手术年龄为(22.27 ± 26.82)月,其中术后住院时间较短组为(22.85 ± 24.73)月,术后住院时间较长组为(21.28 ± 30.36)月,无统计学差异(P = 0.774);平均出生体重为(3.43 ± 0.60) kg,其中术后住院时间较短组为(3.34 ± 0.57) kg,术后住院时间较长组为(3.53 ± 0.62) kg,无统计学差异(P = 0.224);平均手术时长为(141.90 ± 37.45)分钟,其中术后住院时间较短组为(141.85 ± 35.49)分钟,术后住院时间较长组为(141.97 ± 41.03)分钟,无统计学差异(P = 0.987);平均体外循环时长为(63.80 ± 20.34)分钟,其中术后住院时间较短组为(62.38 ± 16.97)分钟,术后住院时间较长组为(66.21 ± 25.12)分钟,无统计学差异(P = 0.354);平均主动脉阻断时长为(44.32 ± 32.07)分钟,其中术后住院时间较短组为(45.32 ± 38.87)分钟,术后住院时间较长组为(42.64 ± 15.06)分钟,无统计学差异(P = 0.681)。此外,手术路径在此研究中对室间隔缺损术后恢复具有显著差异(P < 0.05) (如表1所示)。
危险因素 | 总数 | 术后住院时间较短组 | 术后住院时间较长组 | c2或F值 | P值 |
---|---|---|---|---|---|
患儿性别 | |||||
男 | 68 | 39 (57.35%) | 29 (42.65%) | 1.040 | 0.308 |
女 | 37 | 25 (67.57%) | 12 (32.43%) | ||
是否足月 | |||||
否 | 8 | 6 (75.00%) | 2 (25.00%) | 2.915 | 0.088 |
是 | 43 | 18 (41.86%) | 25 (58.14%) | ||
室间隔缺损类型 | |||||
干下型缺损 | 35 | 16 (45.71%) | 19 (54.29%) | 0.758 | 0.384 |
膜周型 | 65 | 46 (70.77%) | 19 (29.23%) | ||
房室管道型缺损 | 3 | 1 (33.33%) | 2 (66.67%) | ||
肌型 | 2 | 1 (50.00%) | 1 (50.00%) | ||
是否合并肺动脉高压 | |||||
否 | 34 | 20 (58.82%) | 14 (41.18%) | 0.031 | 0.860 |
是 | 44 | 25 (56.82%) | 19 (43.18%) | ||
是否合并其他系统畸形 | |||||
否 | 101 | 62 (61.39%) | 39 (38.61%) | 0.208 | 0.649 |
是 | 4 | 2 (50.00%) | 2 (50.00%) | ||
手术方式 | |||||
补片 | 102 | 62 (60.78%) | 40 (39.22%) | 0.042 | 0.838 |
直接缝合 | 3 | 2 (66.67%) | 1 (33.33%) | ||
手术路径 | |||||
胸骨正中切口 | 86 | 46 (53.49%) | 40 (46.51%) | 11.019 | 0.001 |
右侧腋下切口 | 19 | 18 (94.74%) | 1 (5.26%) |
表1. 室间隔缺损患儿术后恢复单因素分析结果
以是否患有室间隔缺损术后住院时长是否大于10天为因变量,根据两个独立样本t检验或卡方检验或Fisher检验结果拟合Logistics回归模型,结果显示,室间隔缺损类型、手术路径是影响室间隔缺损患儿术后恢复时长的独立因素(P < 0.05)。室间隔缺损为膜周型患儿术后恢复的风险较室间隔缺损为干下型减少50.5% (OR: 0.395; 95%CI: 0.155~0.999);手术路径为右侧腋下切口患儿术后恢复的风险较胸骨正中切口减少94.6% (OR: 0.054; 95%CI: 0.005~0.587) (如图1所示)。
图1. Logistic回归模型结果
近年来先天性心脏病发病率呈大幅上升趋势,室间隔缺损作为最常见的先心病类型,发病率也呈不断上升趋势。有一小部分室间隔缺损患儿生后自然愈合,然而大部分不能自然愈合,需后期通过手术治疗给予纠正恢复正常生理结构及血液循环。本研究显示室间隔缺损类型为膜周型可减少患儿开胸手术后的住院时间,这可能与干下型室间隔缺损的外科治疗与膜周型室间隔缺损的治疗显着不同。漏斗部(干下)间隔的一部分缺失会导致主动脉瓣右尖角脱垂,这使这些患者容易发生主动脉瓣关闭不全。手术暴露是通过肺动脉,主动脉,右心室或右心房进行的,部分患儿需同时治疗主动脉瓣关闭不全 [
先前Leena Mildh等回顾性分析了5年内接受过心脏直视手术的1001例儿童研究发现,体外循环时间更长,肌钙蛋白-T水平更高,患儿术后发生结节性异位心动过速的几率更大,影响患儿术后恢复 [
室间隔缺损类型为膜周型、手术路径为右侧腋下切口会降低患室间隔缺损患儿术后恢复的风险,有利于对患儿进行术前评估,为临床术前工作的实施提供参考策略。
我们对所有在本研究中参与患儿信息采集和诊断工作的所有工作人员深表谢意。
作者同意文章的发表。
尚未声明。
本研究病例信息收集已获得病人及家属的知情同意。
金 肖. 探讨影响室间隔缺损术后恢复的危险因素Explore the Risk Factors That Affect the Recovery after Surgery for Ventricular Septal Defect[J]. 临床医学进展, 2021, 11(04): 1544-1550. https://doi.org/10.12677/ACM.2021.114221