标题：单纯性完全性肺静脉异位引流院内死亡的危险因素分析

      作者：郭亚鹏 1，王健生 2，高宏 1，张雅宁 1，张圣惠 1，赵堃 1，孙舜楠 1，曾新艳 3    1.西安交通大学医学部附属西北妇女儿童医院心脏中心，陕西 西安 710061；2.西安交通大学第一附属医院胸外科，陕西 西安 710061；3.西安交通大学医学部附属西北妇女儿童医院内科，陕西 西安 710061

      卷次： 2021年32卷3期

      【摘要】 目的 分析单纯性完全性肺静脉异位引流择期手术患儿院内死亡的危险因素。方法 回顾性分析2015年1月至2019年12月于西安交通大学附属西北妇女儿童医院心脏中心开展的42例单纯性完全性肺静脉异位引流择期手术患儿的临床资料。根据患儿术后院内死亡情况分为死亡组4例和治愈组38例。比较死亡组与治愈组患儿术前、术中及术后各项变量指标，再将有意义的变量纳入Logistic回归分析，评估单纯性完全性肺静脉异位引流术后早期死亡的危险因素。结果 4例(9.5%)患儿住院死亡；单因素分析结果显示，术时低龄、低体重、术前肺静脉梗阻、术前低血氧饱和度、长时间体外循环、长时间主动脉阻闭、术后低心排血量综合征、术后胸部感染、术后长时间机械通气和术后长时间血管活性药物支持是院内死亡的重要危险因素(P<0.05)；二元逐步Logistic回归分析显示，术后低心排血量综合征和术后长时间机械通气是院内死亡的独立危险因素(P<0.05)。结论 择期手术矫治单纯性完全性肺静脉异位引流可以取得满意的效果，而术后低心排血量综合征和术后长时间机械通气是院内死亡的独立危险因素。
      【关键词】 完全性肺静脉异位引流；外科手术；住院死亡；危险因素
      【中图分类号】 R543.6 【文献标识码】 A 【文章编号】 1003—6350（2021）03—0305—04

Risk factors of in-hospital mortality in isolated total anomalous pulmonary venous drainage.
GUO Ya-peng 1,WANG Jian-sheng 2, GAO Hong 1, ZHANG Ya-ning 1, ZHANG Sheng-hui 1, ZHAO Kun 1, SUN Shun-nan 1, ZENG Xin-yan 3.1. Department of Cardiovascular Surgery, the Northwest Women and Children's Hospital Affiliated to Xi'an JiaotongUniversity, Xi'an 710061, Shaanxi, CHINA; 2. Department of Thoracic Surgery, the First Affiliated Hospital of Xi'anJiaotong University, Xi'an 710061, Shaanxi, CHINA; 3. Department of Cardiovascular Medicine, the Northwest Women andChildren's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710061, Shaanxi, CHINA
【Abstract】 Objective To analyze the risk factors of in-hospital mortality in children undergoing elective opera-tion for isolated total anomalous pulmonary venous drainage (TAPVD). Methods A retrospective analysis was per-formed on the clinical data of 42 children with TAPVD during elective surgery at the Heart Center of Northwest Womenand Children's Hospital Affiliated to Xi'an Jiaotong University from January 2015 to December 2019. Operation relatedindexes were analyzed between death group (4 cases) and survival group (38 cases). Risk factors of early postoperativemortality were analyzed by logistic regression analysis. Results There were 4 cases (9.5%) died in hospital. Univariateanalysis showed that low age and weight at surgery, preoperative pulmonary venous obstruction, preoperative low oxy-gen saturation, long cardiopulmonary bypass and aortic cross clamp times long duration of mechanical ventilatio, chestinfection, postoperative low CO syndrom and long postoperative inotropic support were important risk factors for in-hos-pital mortality (P<0.05). Backward logistic regression analysis showed that postoperative low cardiac output syndromeand prolonged postoperative mechanical ventilation were independent risk factor for in-hospital mortality (P<0.05).Conclusion Elective surgical correction of TAPVD can achieve satisfactory results, and postoperative low cardiacoutput syndrome and prolonged postoperative mechanical ventilation were independent risk factors for in-hospitalmortality.
      【Key words】 Total anomalous pulmonary venous drainage (TAPVD); Surgery; In-hospital mortality; Risk factors