目的 总结完全型房室间隔缺损的矫治手术特点,通过危险因素分析,探讨提高外科疗效的方法。方法 回顾2009-01至2018-12解放军总医院第三医学中心152例完全型房室间隔缺损矫治手术的临床特点,根据围术期(手术后至出院期间)是否发生恶性事件分为两组,A组围术期发生恶性事件共18例,B组未发生围术期恶性事件共134例。通过Logistic回归分析的方法确定影响外科疗效的危险因素。结果 152例围术期发生恶性事件18例(11.8%),包括低心输出量综合征6例,肺动脉高压危象4例,全身毛细血管渗漏综合征4例,室间隔残余分流(直径≥5 mm)者2例,二尖瓣重度反流1例,Ⅱ度Ⅱ型房室传导阻滞1例。Logistic回归分析显示年龄(OR=1.063,95%CI 1.406~1.082)、肺动脉收缩压(OR=1.038,95%CI 1.012~1.070)、术前左侧房室瓣反流程度(OR=1.296,95%CI 1.193~1.387)和主动脉阻断时间(OR=1.172,95%CI 1.008~1.352)是围术期发生恶性事件的独立危险因素(P<0.05)。结论 选择合理手术年龄、降低肺动脉压力、采用有效手术方法、保护房室瓣膜功能是提高完全型房室间隔缺损矫治手术疗效的主要措施。
Abstract
Objective To summary operative characteristics and evaluate the risk factors for correction of complete atrioventricular septal defect(CAVSD)in order to improve the surgical treatment.Methods We reviewed the information of 152 consecutive patients who underwent the correction of CAVSD from 2009 to 2018.The patients were divided into two groups based on post-operative vicious complications The effect of operation and the risk factors for the early post-operative death and vicious complications were analyzed by Logistic regression analysis.Results 18 patients(11.8% ) suffered from vicious complications at the early post-operative stage, including 6 patients low cardiac output syndrome, 4 patients pulmonary hypertensive crisis,4 patients capillary leak syndrome,2 patients ventricular septal defect(diameter≥5 mm),one patient Ⅱ°Ⅱ type atrioventricular block. The statistic analysis indicated that age(OR=1.063,95%CI 1.406-1.082), pulmonary artery systolic pressure(OR=1.038,95%CI 1.012-1.070),left atrioventricular valve regurgitation(OR=1.296,95%CI 1.193-1.387)and aortic cross clamp time(OR=1.172,95%CI 1.008-1.352) were the high risk factors for vicious complications(P<0.05).Conclusions To improve the effect of operation, we can choose appropriate age at the time of surgery, reduce pulmonary arterial hypertension, use reasonable surgical procedure and protect atrio-ventricular valve.
关键词
完全型房室间隔缺损 /
外科疗效 /
危险因素
Key words
complete atrioventricular septal defect /
surgical effect /
risk factors
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参考文献
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