南方医科大学学报2016，Vol.36Issue(12)：1660-1666,7.DOI:10.3969/j.issn.1673-4254.2016.12.12
小儿重症及复杂先天性心脏病术后急性呼吸窘迫综合征的危险因素分析
Risk factors for acute respiratory distress syndrome following surgeries for pediatric critical and complex congenital heart disease
摘要
Abstract
Objective To explore the risk factors for acute respiratory distress syndrome (ARDS) in children receiving surgeries for critical and complex congenital heart disease (CCHD).Methods According to the 2011's Berlin definition of ARDS,the clinical data were collected from 75 children without ARDS (group Ⅰ) and 80 children with ARDS (group Ⅱ) following surgeries for CCHD performed in the Department of Cardiac Surgery of our hospital from January,2009 to May,2014.Univariate analyses and logistic regression were used to analyze the risk factors contributing to the occurrence of ARDS following the surgeries.Results In the 80 patients who developed ARDS postoperatively in group Ⅱ,27 had mild ARDS,25 had moderate ARDS,and 28 had severe ARDS;death occurred in 17 (21％) cases.Univariate analyses showed that 23 parameters were significantly different between groups Ⅰ and Ⅱ (P＜0.05),including weight;preoperative PCO2,left ventricular ejection fraction,pulmonary artery pressure,pulmonary infection,and coagulation abnormalities;early postoperative serum globulin;intraoperative aortic cross clamp (ACC) time;cardiopulmonary bypass (CPB) time;operation time;blood loss and blood transfusion amount intraoperatively and during the first 8 h after operation;lactic add level immediately after the operation and its maximum increasing rate within 24 h postoperatively;postoperative serum levels of albumin and creatinine;serum levels of B-type natriuretic peptide,procalcitonin,C-reactive protein,and prealbumin 24 h after operation;and age.Logistic regression analyses showed that intraoperative ACC time,CPB time,the maximum increasing rate of lactic acid within 24 h after operation,serum procalcitonin 24 h after operation and intraoperative blood loss were independent risk factors for postoperative ARDS.Conclusion The risk factors of ARDS identified in these children can predict the occurrence of ARDS following the surgeries and timely interventions can improve the success rate in treatment of postoperative ARDS in children with CCHD.关键词
重症及复杂先天性心脏病/急性呼吸窘迫综合征/危险因素Key words
critical and complex congenital heart disease/acute respiratory distress syndrome/risk factor引用本文复制引用
龚书榕,张颖蕊,于荣国..小儿重症及复杂先天性心脏病术后急性呼吸窘迫综合征的危险因素分析[J].南方医科大学学报,2016,36(12):1660-1666,7.基金项目
国家临床重点专科建设项目(财社(2011)170号)National Clinical Key Specialty (2011-170). （财社(2011）
