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目的探讨影响大动脉调转术(ASO)治疗完全性大动脉转位(D-TGA)患儿死亡的危险因素,以提高手术治愈率。方法选择本院2001年9月-2009年3月行ASO、≤4月龄D-TGA婴儿135例,确定潜在危险因素后收集其临床资料,利用单因素分析及多因素Logistic回归分析,最终确立ASO术中及术后30 d内死亡的危险因素。结果 D-TGA患儿术中或术后30 d内死亡27例,病死率为20%(27/135例),其中2001-2003年死亡4/8例(50%),2004-2006年死亡16/44例(36.4%),2007-2009年死亡7/83例(8.4%)。Logistic回归分析提示冠状动脉异常(OR=22.476,P=0.041)、体外循环时间(OR=1.024,P=0.000)、主动脉阻断时间(OR=0.982,P=0.019)、术后严重低心排综合征(OR=8.166,P=0.023)、术后肾衰竭(OR=9.809,P=0.046)是行ASO治疗D-TGA患儿死亡的主要影响因素。结论伴有冠状动脉异常、体外循环及主动脉阻断时间长、术后并发严重低心排综合征和肾衰竭是预测行ASO治疗D-TGA患儿死亡的重要指标。
Objective To investigate the risk factors of death in children undergoing transposition of aorta (ASO) for treatment of complete aortic transposition (D-TGA) to improve the cure rate. Methods 135 cases of D-TGA infants aged ASO ≤ 4 months were selected from September 2001 to March 2009 in our hospital. The clinical data were collected after determining the potential risk factors. Univariate analysis and multivariate Logistic regression analysis were used to establish the final results ASO intraoperative and postoperative 30 d risk factors for death. Results Twenty-seven patients died of D-TGA intraoperatively or within 30 days after operation, with a mortality rate of 20% (27/135 cases), of which 4/8 (50%) died in 2001-2003 and died in 2004-2006 16/44 cases (36.4%), 7/83 cases (8.4%) deaths in 2007-2009. Logistic regression analysis showed that the abnormalities of coronary artery (OR = 22.476, P = 0.041), cardiopulmonary bypass time (OR = 1.024, P = 0.000) (OR = 8.166, P = 0.023) and postoperative renal failure (OR = 9.809, P = 0.046) were the main factors affecting the death of children with D-TGA treated with ASO. Conclusions Coronary artery abnormalities, cardiopulmonary bypass and prolonged aorta occlusion are associated with severe low cardiac output syndrome and renal failure. It is an important index for predicting the death of children with D-TGA treated with ASO.