Risk factors of postoperative acute pulmonary reperfusion injury in neonatal severe pulmonary stenosis or pulmonary atresia
10.3760/cma.j.issn.2096-2932.2018.06.001
- VernacularTitle:新生儿危重肺动脉瓣狭窄或闭锁术后急性肺再灌注损伤危险因素分析
- Author:
Xia WANG
1
;
Dongying ZHAO
;
Yonghong ZHANG
;
Jintong TAN
;
Tianwen ZHU
;
Hongping XIA
;
Lijuan XIE
;
Yurong WU
;
Sun CHEN
;
Zhenjuan HE
Author Information
1. 200092,上海交通大学医学院附属新华医院新生儿科
- Keywords:
Reperfusion injury;
Pulmonary valve stenosis;
Pulmonary atrasia;
Percutaneous pulmonary balloon valvuloplasty
- From:Chinese Journal of Neonatology
2018;33(6):401-405
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the clinical features and risk factors of acute pulmonary reperfusion injury after operation in neonates with severe pulmonary stenosis or pulmonary atresia.Method From February 2014 to February 2018,a retrospective analysis was performed in patients with critical pulmonary stenosis or pulmonary atresia who received percutaneous balloon pulmonary valvuloplasty (PBPV) in the neonatal intensive care unit of our hospital.Clinical characteristics,perioperative cardiac structure,hemodynamic data and biochemical results were collected.The neonates were assigned into injury group if they had acute lung reperfusion injury,and non-injury group if not.The risk factors of acute lung reperfusion injury were analyzed using multi-variate Logistic regression model.Result A total of 32 patients (24 prenatal diagnosis and 8 postnatal diagnosis) with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum were enrolled.The main manifestations were dyspnea and cyanosis.Intravenous prostaglandin E was administered to keep the ductus arteriosus open.The age of operation ranged from 1 to 52 days and the median age was 7.5 days.Postoperative acute lung reperfusion injury occurred in 7 cases (21.9％).Preoperative and intraoperative pulmonary valve annulus diameter,balloon diameter,preoperative hemoglobin,hematocrit and blood albumin were significantly lower in the injury group.The operation duration,total length of hospital stay and postoperative duration were longer than in the non-injury group,the differences were statistically significant (P ＜ 0.05).Multi-variate Logistic regression analysis showed that the diameter of pulmonary valve annulus (OR =5.814,95％CI 1.106 ～30.568),preoperative blood albumin (OR =1.361,95％ CI 1.063 ～ 1.742),and hematocrit (OR =1.173,95％ CI 1.010 ～ 1.363) were risk factors of acute lung reperfusion injury,with statistically significant differences (P ＜ 0.05).Conclusion Acute lung reperfusion injury is one of the common complications after the operation of severe pulmonary stenosis or pulmonary atresia.The severity of pulmonary valve annulus stenosis,preoperative hematocrit and blood albumin level may be the risk factors of postoperative acute lung reperfusion injury.
