|本期目录/Table of Contents|

[1]王晓红,史少娟,刘学,等.先天性心脏病合并肺动脉高压患儿行根治术后的预后影响因素分析[J].医学研究与战创伤救治(原医学研究生学报),2021,23(02):131-135.[doi:10.3969/j.issn.1672-271X.2021.02.005]
　WANG Xiao-hong,SHI Shao-juan,LIU Xue,et al.Analysis of influencing factors on postoperative prognosis of children with congenital heart disease complicated with pulmonary hypertension[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2021,23(02):131-135.[doi:10.3969/j.issn.1672-271X.2021.02.005]
点击复制

先天性心脏病合并肺动脉高压患儿行根治术后的预后影响因素分析()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第23卷
期数:
2021年02期
页码:
131-135
栏目:
临床研究
出版日期:
2021-03-22

文章信息/Info

Title:
Analysis of influencing factors on postoperative prognosis of children with congenital heart disease complicated with pulmonary hypertension
作者:
王晓红; 史少娟; 刘学; 杨华
710032西安，西京医院心脏内科(王晓红、史少娟、刘学、杨华)
Author(s):
WANG Xiao-hong;  SHI Shao-juan;  LIU Xue;  YANG Hua
（Department of Cardiology，Xijing Hospital，Xi’an 710032, Shaanxi, China）
关键词:
先天性心脏病; 肺动脉高压; 预后; 影响因素
Keywords:
congenital heart disease;  pulmonary hypertension;  prognosis;  influence factor
分类号:
R725.4
DOI:
10.3969/j.issn.1672-271X.2021.02.005
文献标志码:
A
摘要:
目的分析先天性心脏病合并肺动脉高压患儿术后预后的影响因素。方法回顾性分析西京医院2013年3月至2019年1月收治的127例先天性心脏病合并肺动脉高压患儿临床资料，均于全身麻醉+体外循环下进行一次性根治手术治疗，进行相应随访，统计分析患儿预后情况。结果127例先天性心脏病合并肺动脉高压患儿经手术治疗后114例存活（存活组），13例死亡（死亡组）。存活组和死亡组性别、先天性心脏病类型、营养分级比较差异无统计学意义（P>0.05）；存活组和死亡组年龄[（1.64±0.23） vs （1.01±0.11）岁]、体重[（9.34±1.29）kg vs （5.74±0.78）kg]、肺动脉高压分级重度率[35.09%（40/114） vs 69.23%（9/13）]、心功能分级Ⅲ级率[34.21%（39/114） vs 76.92%（10/13）]、肺动脉高压危象率[8.77%（1/114） vs 23.08%（3/13）]、手术时间[(4.33±0.6）h vs （5.32±0.75）h]、机械通气时间[（1.21±0.12）d vs （2.49±0.31）d]、Tei指数[（0.40±0.04） vs （0.49±0.07）]、BNP[（264.29±34.17）ng/L vs （518.96±73.15）ng/L]、hsTnT[（0.09±0.01）mg/L vs （0.15±0.02）mg/L]、CRP[（4.27±0.61）mg/L vs （12.91±1.23）mg/L]，比较差异均有统计学意义（P<0.05）。COX比例风险回归模型结果显示，肺动脉高压分级、心功能分级、肺动脉高压危象、手术时间、机械通气时间、Tei指数、BNP、hsTnT、CRP是影响患儿预后的危险因素（P<0.05）。结论先天性心脏病合并肺动脉高压患儿术后预后和多种因素相关，通过对相关因素的干预可能对预后改善有一定作用。
Abstract:
ObjectiveTo analyze the influencing factors of postoperative prognosis in children with congenital heart disease complicated with pulmonary hypertension.MethodsThis study retrospectively analyzed the clinical data of 127 children with congenital heart disease complicated with pulmonary hypertension in our hospital from March 2013 to January 2019, followed up accordingly, and the prognosis of the children was counted.Results114 of 127 children with congenital heart disease complicated with pulmonary hypertension survived and 13 died after surgical treatment. There was no significant difference in sex, congenital heart disease type and nutritional grade between survival group and death group (P>0.05). Survival group and death group age (1.64±0.23) vs (1.01±0.11) years, weight (9.34±1.29)kg vs (5.74±0.78) kg, pulmonary hypertension grade severe rate 35.09% (40/114) vs 69.23% (9/13), cardiac function classification Ⅲ Grade I rate 34.21% (39/114) vs 76.92% (10/13), pulmonary hypertension crisis rate 8.77% (1/114) vs 23.08% (3/13), operation time (4.33±0.6) h vs (5.32±0.75) h, mechanical ventilation time (1.21±0.12) d vs (2.49±0.31) d, Tei index (0.40±0.04) vs (0.49±0.07), BNP (264.29±34.17) ng/L vs (518.96±73.15)ng/L, and hsTnT (0.09 ±0.01) mg/L vs (0.15±0.02) mg/L and the ratio of CRP (4.27±0.61) mg/L vs (12.91±1.23) mg/L were statistically different (P<0.05). COX proportional hazard regression model showed that pulmonary hypertension classification, cardiac function classification, pulmonary hypertension crisis, operation time, mechanical ventilation time, Tei index, BNP, hsTnT, CRP were risk factors affecting prognosis of children (P<0.05).ConclusionPostoperative prognosis of children with congenital heart disease complicated with pulmonary hypertension is related to a variety of factors. Intervention on relating factors may play a role in improving prognosis.

参考文献/References:

[1]Meller CH, Grinenco S, Aiello H, et al.Congenital heart disease, prenatal diagnosis and management[J]. Arch Argent Pediatr, 2020,118(2):e149-e161.
[2]杨思慧,张智伟. 先天性心脏病合并肺动脉高压的研究进展[J]. 岭南心血管病杂志,2019,25(3):361-364.
[3]刘芳, 赵趣鸣. 先天性心脏病治疗进展[J]. 中华实用儿科临床杂志, 2019, 34(13):980-985.
[4]孟晓冬,单福祥,王燕慧. 肺动脉高压治疗进展[J]. 心血管病学进展,2016,37(3):319-322.
[5]Kruszka P, Beaton A. The state of congenital heart disease[J]. Am J Med Genet C Semin Med Genet, 2020,184(1):5-6.
[6]徐卓明. 小儿先天性心脏病相关性肺高压诊断和治疗(专家共识)[J]. 中华小儿外科杂志, 2011, 32(4):306-318.
[7]郭宇含, 张钰弦, 韩明, 等. 右美托咪定对先天性心脏病患儿体外循环氧化应激反应的影响[J]. 医学研究生学报, 2019, 32(12):1291-1295.
[8]朱耀斌,李志强,丁楠,等. 先天性心脏病患儿术后心脏康复研究进展[J]. 中华实用诊断与治疗杂志,2019,33(4):410-413.
[9]段永建. 肺动脉高压病因及治疗研究进展[J]. 西部医学, 2016, 28(8):1178-1180.
[10]徐茁原, 李强强, 顾虹. 先天性心脏病相关肺动脉高压研究进展[J]. 中华实用儿科临床杂志, 2019, 34(13):1030-1032.
[11]徐茁原, 李强强, 刘倩, 等. 先天性心脏病术后肺动脉高压与特发性肺动脉高压患者的临床特点与预后[J]. 中国医药, 2017, 12(12):1794-1797.
[12]Lykkeberg B, Noergaard MW, Bjerrum M.Experiences and expectations of parents when young people with congenital heart disease transfer from pediatric to adult care: a systematic review protocol[J]. JBI Database System Rev Implement Rep, 2020,18(3):633-639.
[13]Pettitt TW.Quality Improvement in Congenital Heart Surgery[J]. Neoreviews, 2020,21(3):e179-e192.
[14]孙彬峰,吴炳祥. 先天性心脏病相关性肺动脉高压的自然病程与预后影响因素[J]. 心血管康复医学杂志,2019,28(2):256-259.
[15]Shin YR, Yang YH, Park YH, et al.Emergency Pulmonary Artery-to-Systemic Artery Shunt to Break the Positive Feedback Loop of a Pulmonary Hypertensive Crisis after Neonatal Coarctation Repair[J]. Korean J Thorac Cardiovasc Surg, 2019,52(4):232-235.
[16]Puz＇ańska J, Ostrowska K, Moll J, et al.PDA stenting in 6-month-old infant with suprasystemic pulmonary hypertension as a treatment option for hypertensive crisis[J]. Postepy Kardiol Interwencyjnej, 2019,15(3):371-373.
[17]Ichiyanagi S, Takeshita I, Kandil AI, et al.Pulmonary Hypertensive Crisis During General Anesthesia in a 3-Year-Old Autistic Boy With Undiagnosed Scurvy, Undergoing Cardiac Catheterization: A Case Report[J]. A A Pract, 2019，13(10):379-381.
[18]Vayalthrikkovil S, Vorhies E, Stritzke A, et al. Prospective study of pulmonary hypertension in preterm infants with bronchopulmonary dysplasia[J]. Pediatr Pulmonol, 2019,54(2):171-178.
[19]Suto M, Matsumoto K, Kido S, et al.Advanced Pulmonary Hypertension Due to Congenital Double-shunt Successfully Treated with Surgical Repair and Up-front Combination Therapy[J]. Intern Med, 2019,58(9):1301-1305.
[20]Rush B, Biagioni BJ, Berger L, et al. Mechanical Ventilation Outcomes in Patients With Pulmonary Hypertension in the United States: A National Retrospective Cohort Analysis[J]. J Intensive Care Med, 2017,32(10):588-592.
[21]Alrddadi SM, Morsy MM, Albakri JK,et al.Risk factors for prolonged mechanical ventilation after surgical repair of congenital heart disease. Experience from a single cardiac center[J]. Saudi Med J, 2019,40(4):367-371.
[22]陆艳萍, 韩炜, 肖小琴. 肺动脉高压患者RVFAC与右心室Tei指数、血浆B型利钠肽前体的相关性[J]. 中国临床研究, 2016, 29(10):1396-1398.
[23]李竑, 郑叙锋, 高洁, 等. 术前B型脑钠肽对风湿性心脏病患者手术治疗风险及预后的评估价值研究[J]. 贵州医药, 2019, 43(2):225-227.
[24]杨雨航, 裴亮, 卢志超,等. 脑钠肽在左向右分流型先天性心脏病合并心力衰竭中的诊断价值[J]. 中国小儿急救医学, 2017, 24(5):355-359.
[25]张少景, 王青. 高敏肌钙蛋白T影响因素的研究进展[J]. 北京医学, 2016,38(2):152-154.
[26]Poredo P. C-reactive protein and the risk of cardiovascular morbidity and mortality[J]. Vasa, 2017,46(2):77-78.
[27]苏建军,韩允.先天性心脏病合并肺动脉高压患儿血清尿酸、C-反应蛋白与NT-proBNP的检测及临床意义[J].现代预防医学,2019,46(10):1910-1912，1916.

相似文献/References:

[1]郭维琼,钱维源,安 平,等.超声协助介入封堵治疗先天性心脏病4例[J].医学研究与战创伤救治(原医学研究生学报),2009,11(03):245.
[2]周亚军,徐 靖,许国安,等.单向活瓣补片治疗合并重度肺动脉高压 双向分流型室间隔缺损[J].医学研究与战创伤救治(原医学研究生学报),2008,10(01):40.
[3]仲崇翔,华 明,武海娟.伴肺动脉高压的POEMS综合征1例[J].医学研究与战创伤救治(原医学研究生学报),2008,10(01):50.
[4]游昕,陈若为,马游,等.婴幼儿先天性心脏病心内直视手术98例报告[J].医学研究与战创伤救治(原医学研究生学报),2008,10(04):256.
　YOU Xin,CHEN Ruo-wei,MA You,et al.Experience of open heart surgery in 98 infants with congenital heart disease[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2008,10(02):256.
[5]游 昕,潘雪飞.中型综合性医院婴幼儿心脏手术的持续质量改进[J].医学研究与战创伤救治(原医学研究生学报),2014,16(01):45.
　YOU Xin,PAN Xue-fei..Continuous quality improvement for the cardiac surgery of infants in medium-sized hospital[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2014,16(02):45.
[6]库德热提·艾比布拉.先天性心脏病介入封堵术的临床疗效评价[J].医学研究与战创伤救治(原医学研究生学报),2014,16(03):304.[doi:10.3969/j.issn.1672-271X.2014.03.026]

备注/Memo

备注/Memo:
基金项目：陕西省社会发展科技攻关项目（2015SF107）
更新日期/Last Update: 2021-03-22