Yu Xindi,Du Xinwei,Wang Wei,et al. Mortality analyses for children with congenital heart disease after cardiopulmonary bypass.[J].Journal of Clinical Pediatric Surgery,2018,17(12):911-916.
小儿先天性心脏病体外循环术后死亡原因的分析与探讨
- Title:
- Mortality analyses for children with congenital heart disease after cardiopulmonary bypass.
- Keywords:
- ; Heart Disease/CN; Extracorporeal Circulation; Mortality; Surgical Procedures; Operative; Child
- 文献标志码:
- A
- 摘要:
- 目的回顾性分析23 500例先天性心脏病（congenital heart disease,CHD）患儿行体外循环术后发生死亡的原因及并发症，为进一步改善CHD的治疗效果提供参考。方法回顾性收集2009—2016年由上海交通大学医学院附属上海儿童医学中心收治的23 500例CHD患儿作为研究对象，重点分析体外循环术后死亡患儿的病种、年龄、死亡原因和并发症。结果23 500例婴幼儿先天性心脏病术后共死亡569例，病死率为2.42%。死亡患儿与存活患儿比较，CPB时间、主动脉阻断时间显著延长，差异有统计学意义（P<0.05）。2016年，CHD患儿的病死率仅为1.68%。除了2016年的手术总数比2015年略有下降外，2009—2015年的CHD病例数呈现逐年递增的趋势。从2011年起，由于手术总数开始增加（较2010年增加了349例），所以死亡例数也同步增多，但病死率依旧呈现下降的趋势。569例死亡患儿中6个月以下死亡占比较高，其中又以＜3个月的患儿占比最高(35.50%)。主要死亡原因依次为低心排出量综合征（67.74%）、呼吸系统并发症（15.93%）、多器官功能衰竭（11.49%）和心律失常（7.66%）。结论畸形复杂程度和年龄是影响先天性心脏病术后死亡率的主要因素。围手术期心功能的保护仍是进一步改进的重点。
- Abstract:
- ObjectiveTo explore the cause of death and the complications of age in 569 deceased children after cardiopulmonary bypass so as to provide rationales for improving the prognosis of congenital heart disease (CHD) after open heart surgery.MethodsFrom 2009 to 2016,569 CHD cases were selected as the observation objects to compare the types of malformation,age,postoperative mortality and complications.ResultsAmong 23,500 cases,569 patients died postoperatively with a mortality rate of 2.42%.Compared with surviviors,CPB time and aortic occlusion time were significantly longer in deceased children and the difference was statistically significant (P<0.05).The mortality rate of CHD children was only 1.68% by 2016.Compared to 2015,besides a slight drop in total number of operations in 2016,the number of cases from 2009 to 2015 has shown an growing trend yearbyyear.Since 2011,as the total number of operations began to increase (compared with 2010,an increase of 349 children),the number of deaths has increased simultaneously,but the mortality rate is still declining.Of all cases,the mortality rate of 6monthold infants was higher while 3monthold counterparts had the highest rate (35.50%).The major causes of death were low cardiac output syndrome(67.74%),respiratory failure (15.93%),multiple organ dysfunction syndrome (11.49%) and cardiac arrhythmia (7.66%).ConclusionThe mortality rate of CHD children is correlated with the complexity of malformation and negatively related with patient age.Protection of heart function is vital for decreasing the postoperative mortality of CHD.
相似文献/References:
[1]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[2]刘婷婷 张钦明 周红 焦丽丽 陈永卫. 肠内营养在儿童胰腺外伤治疗中的应用[J].临床小儿外科杂志,2011,10(02):84.
LIU Ting ting,ZHANG Qin ming,ZHOU Hong,et al. Enteral nutrition treatment in the application of pancreas trauma of children.[J].Journal of Clinical Pediatric Surgery,2011,10(12):84.
[3]吴卫卫 汪健 黄顺根. 肠外营养导致大鼠肝细胞炎症因子及受体基因表达的变化及临床意义[J].临床小儿外科杂志,2011,10(02):87.
Parenteral Nutrition Leads to Alteration of Inflammation Cytokines and Receptors Gene Expression in the Rat[J].Journal of Clinical Pediatric Surgery,2011,10(12):87.
[4]于增文 杨杨 李索林 耿娜 李英超 李萌 马亚贞. 腹腔镜下十二指肠单层缝合吻合术的实验研究与临床应用[J].临床小儿外科杂志,2011,10(02):90.
YU Zen gwen,YANG Yang,LI Suo lin,et al. The experimental studies and clinical applications of laparoscopic duodenal singlelayer sutured anastomosis in children.[J].Journal of Clinical Pediatric Surgery,2011,10(12):90.
[5]徐织 王剑 傅启华 杨波 宋云海 鲍南.中国人群神经管缺陷VANGL1基因突变的筛查及关联研究[J].临床小儿外科杂志,2011,10(02):94.
Mutation screening and associated study of VANGL1 gene in chinese patients with Neural Tube Defects.[J].Journal of Clinical Pediatric Surgery,2011,10(12):94.
[6]吴臻斐 林孝坤 秦乐 林进汉 李仲荣 陈肖鸣. 西地那非对大鼠单侧睾丸扭转后对侧睾丸的影响及作用研究[J].临床小儿外科杂志,2011,10(02):101.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):101.
[7]王贤书 张晓茹 杨志国 程征海 岳芳 曹红宾 李德泽. 脑室腹腔分流术治疗婴儿脑积水120例 [J].临床小儿外科杂志,2011,10(02):105.
[8]杨洋 张潍平 彭芸 温洋 杨吉刚.两种输尿管不全梗阻肾积水动物模型制作方法的比较[J].临床小儿外科杂志,2011,10(02):107.
Comparison of two different methods to establish animal model of hydronephrosis due to incomplete ureteral obstruction.[J].Journal of Clinical Pediatric Surgery,2011,10(12):107.
[9]俞钢 朱小春 葛午平 林炎坤 金龙 劳伟华 史浩 肖尚杰 洪淳 周佳亮 傅晓静. 胎儿外科相关疾病的产前诊断及干预[J].临床小儿外科杂志,2011,10(02):111.
The antenatal diagnosis, tassessment, and therapy of fetal surgical anomalies[J].Journal of Clinical Pediatric Surgery,2011,10(12):111.
[10]刘国庆 王剑锋 朵永福 李杰荣 陈一平 黄振强 叶章群. 妊娠期尿结石对胎儿早产流产的影响[J].临床小儿外科杂志,2011,10(02):115.
Urolithiasis influence to develop of fetus in gestation period[J].Journal of Clinical Pediatric Surgery,2011,10(12):115.
[11]丁晋阳 莫绪明 顾海涛 孙剑 彭卫 戚继荣 沈立 束亚琴 钱龙宝. 延迟关胸技术在婴儿复杂危重先心病手术中的应用[J].临床小儿外科杂志,2011,10(02):98.
DING Jin yang,MO Xu ming,GU Hai tao,et al. Delayed Sternal Closure following operations for complex and severe congenital heart disease in infant[J].Journal of Clinical Pediatric Surgery,2011,10(12):98.
[12]仇杰 费忠化 刘宏生. 婴幼儿先心病术后并发纵膈气肿临床分析[J].临床小儿外科杂志,2012,11(04):260.
[J].Journal of Clinical Pediatric Surgery,2012,11(12):260.
[13]杨丽君 林茹 叶莉芬. 小儿先天性心脏病手术中残余机血洗涤回输对凝血功能的影响[J].临床小儿外科杂志,2012,11(06):409.
[J].Journal of Clinical Pediatric Surgery,2012,11(12):409.
[14]孙剑 莫绪明 钱龙宝. 儿童先心病手术后胸骨-纵隔感染的预防和治疗[J].临床小儿外科杂志,2013,12(05):395.
[15]郭健 李晓峰 刘晖. 先心病手术后植入永久起搏器治疗房室传导阻滞[J].临床小儿外科杂志,2014,13(03):188.
[16]陈仁伟 罗金文 曾德斌. 右腋下小切口在小儿心内直视手术中的应用研究[J].临床小儿外科杂志,2014,13(03):214.
[17]石磊,翟波,杨房,等. 婴幼儿危重先天性心脏病急诊根治手术时机的初步探讨[J].临床小儿外科杂志,2018,17(12):931.
Shi Lei,Zhai Bo,Yang Fang,et al. Emergency primary repair of critical congenital heart disease in neonates and infants.[J].Journal of Clinical Pediatric Surgery,2018,17(12):931.