摘要
目的探讨小儿先天性心脏病(先心病)术后多脏器功能障碍(MODS)预后情况及其影响因素,为对此类患儿进行针对性护理提供依据。方法收集先心病术后并发MODS77例患儿的临床资料。结果11例放弃治疗出院,66例中44例救治存活,22例死亡。出现时间最早、累及最多的脏器为心脏;病死率最高的为累及中枢神经系统的患儿(57.69%),其次是累及血液系统的患儿(55.56%);患儿的病死率与累及脏器的数量呈显著正相关(P<0.01)。死亡患儿手术体外循环时间和主动脉阻断时间显著长于存活患儿(均P<0.05),术中意外及术后心肺复苏发生率显著高于存活患儿(均P<0.05)。结论先心病术后患儿应加强心功能监护,特别是体外循环时间>120min,主动脉阻断时间>60min及术中发生过意外情况、术后采取过心肺复苏术的患儿;尽早采取有利措施避免其他脏器功能受损是提高患儿存活率的关键。
Objective To examine the prognosis of multiple organ dysfunction syndrome （MODS） in children with conge nital heart disease after open heart surgery, Methods Clinical data of 77 children who received operation for congenital diseases and developed multiple organ dysfunction were collected. Results Eleven children were discharged as they decided to gave up treatment. Among the remaining 66 patients, 44 were alive after treatment and 22 died. The heart is the organ that was involved most and earliest. The children with CNS involvement had the highest mortality （57.69%）, and next came the children with involvement of blood system （55.56%）. The mortatlity of the children was positively correlated with the number of organs involved （P〈0.01）. The time of extracorporeal circulation and aorta blockage was much longer in children who died than in the alive patients （P〉0.05 for all） and incidences of intraoperative emergencies and cardiopulmonary resuscitation were significantly higher in the chidren who died than the alive patients （P〉0.05 for all）. Conclusion Postoperatively the cardiac functions of the children with congenital heart disease should be carefully monitored, especially these with extracorporeal circulation time longer than 120 min and with time of aorta blockage greater than 60 min and those who had received eardiopulmonary resuscitation. Taking early measures to avoid damage of other organs is the key to the success of operation.
关键词
先天性心脏病
儿童
多脏器功能障碍
心脏直视术
预后
数据收集
congenital heart defects
children
multiple organ dysfunction syndrome
cardiac surgery
prognostic
data collection
