Analysis of the effect of the simultaneous combined operation for congenital heart disease complicated with non-cardiac malformation
10.3760/cma.j.cn101070-20190624-00567
- VernacularTitle:先天性心脏病并非心脏畸形同期联合手术疗效分析
- Author:
Wei ZHANG
1
;
Xinpeng QU
;
Guangning QIN
;
Shuangxing WANG
;
Hui ZHANG
;
Yi LUO
Author Information
1. 首都儿科研究所附属儿童医院心脏外科 100020
- From:
Chinese Journal of Applied Clinical Pediatrics
2020;35(20):1571-1576
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the safety and feasibility of the simultaneous combined operation in children with congenital heart disease complicated with non-cardiac malformation.Methods:A total of 72 children undergoing combined surgery or simple heart surgery in the Department of Cardiac Surgery, Children′s Hospital, Capital Institute of Pediatrics from January 2017 to January 2019 were enrolled.According to the severity of the disease, patients in the combined operation group (group A) and the simple heart surgery group (group B) were separately subdivided into the low risk group (group L) and the high risk group (group H). There were 36 children in group A, with the age ranging from 1.5 to 168.0 months old (median: 18.0 months). There were 36 cases in group B, with the age ranging from 1.0 to 170.0 months old (median: 19.0 months). Patients in groups A and B were sent to the cardiac intensive care unit(ICU) after operation.The cardiopulmonary bypass (CPB) time, aortic clamping (ACC) time, tracheal intubation time, intensive care unit (ICU) retention time, brain natriuretic peptide (BNP), alanine aminotransferase (ALT) and creatinine (Cr) were recorded.Besides, the cardiac output index (CI), cardiac circulation efficiency (CCE), maximum pressure gradient (dp/dt), lactic acid (Lac), blood glucose (Glu), inotropic score (IS) were also recorded at the time of returning to ICU (T0), 4 hours after operation (T1), 8 hours after operation (T2), 12 hours after operation (T3), 24 hours after operation (T4) and 48 hours after operation (T5), respectively.Results:(1) Intra-group comparison in group A: the age [(39.9±37.0) months], height [(94.1±20.1) cm] and weight [(14.4±6.7) kg] of children at low risk (group L-A) were significantly higher than those at high risk (group H-A) [(7.5±3.7) months, (68.1±6.4) cm, (7.8±2.2) kg] (all P<0.01). The CPB time [(37.0±23.6) min], ACC time [(19.1±13.4) min], endotracheal intubation time [(7.1±4.7) h], ICU retention time [(1.1±0.3) d] and BNP 24 hours after operation [(2 257.3±952.0) ng/L] in group L-A were significantly lower than those in group H-A [(84.7±28.4) min, (41.9±30.7) min, (71.0±67.6) h, (8.7±5.7) d and (5 327.2±992.9) ng/L] (all P<0.01). Glu, IS, CI, CCE were significantly different between patients at low risk and patients at high risk ( P<0.05). At the time of T0-T5, the Glu( F=4.43, P<0.05) and IS ( F=26.99, P<0.01)of group L-A were lower than those of group H-A, and the CI ( F=18.39, P<0.01)and CCE ( F=5.28, P<0.05) of group L-A were higher than those of group H-A.(2) Comparison between groups A and B: there was no significant difference in age, height, weight, CPB time, ACC time, hemodynamic parameters, arterial blood gas parameters and postoperative clinical indexes between patients at high risk or patients at low risk in group A and group B (all P>0.05). Conclusions:(1) For the patients at low risk, hemodynamics remains stable after the combined operation.The combined operation does not increase the endotracheal intubation time and ICU retention time, so it is safe and feasible.(2) For the patients at high risk, hemodynamics is also stable after the combined operation.However, their IS is higher than that of patients at low risk at any time point, and the incidence of postoperative adverse events is higher than that of patients at low risk.It is necessary to evaluate the condition and operation plan of the children before operation.
