Objective To investigate the influence of intensive insulin therapy on the short-term prognosis in children after cardiac surgery.Methods A total of 320 children including 192 males and 128 females who underwent cardiac surgery were enrolled in this study from Jan 2009 to Dec 2010 at the cardiac surgery department of Chengdu cardiovascular hospital.The age of these children ranged from 3 months to 12years old.According to insulin administration time and blood glucose control level,they were randomly divided into two groups.In group A,there were 165 patients who received continuous insulin infusion to maintain postoperative gloucose levels between 4.4 and 6.1 mmol/L,while 155 patients in group B received insulin infusion when their glucose levels were higher than 11.1 mmol/L to control the levels between 6.1 and 11.1 mmol/L.Then the postoperative complications and blood glucose controlling were compared and analyzed.Results A total of 320 children were enrolled,and 4 800 recorded data were analyzed.The mean blood glucose level was (5.58 ±0.54) mmol/L in group A and (7.73 ±0.85) mmol/L in group B (P ＜0.01 ),and both of them were controlled within the target range.The incidence of hypoglycemia ( ＜3.3 mmor/L) was 1.65％ (38/2310)in group A and 1.04％ (26/2490) in group B.The incidence of severe hypoglycemia ( ＜2.2 mmol/L) was 0.13 ％ ( 3/2 310 ) in group A and 0.08 ％ ( 2/2 490 ) in group B.The incidences of hypoglycemia and severe hypoglycemia were significantly increased in group A compared to group B ( P ＜0.01 ).The incidence of infection in group A was lower than that in group B [3.03％ (5/165) vs 9.68％ (15/155),P ＜0.05],but there was no significant difference between the two groups in the incidences of malignant arrhythmia,circulation failure or shock,multiple organ dysfunctive syndrome and mortality.Conclusion Intensive insulin therapy can't improve the short-term prognosis in children after cardiac surgery.

Objective To analyze the risk factors for ventilator-associated pneumonia(VAP)in children after cardiopulmonary bypass(CPB).Methods Between January 2003 and June 2010,116 consecu tive cases receiving postoperative ventilation for more than 48 hours were included in this study.The patients were assigned into a VAP group(n =57)and non-YAP group(n =59).Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results The overall incidence of VAP was 4.18％(57/1 365).The mortality of VAP was 26.32％(15/57).Univariate risk factors included severe pulmonary hypertension,CPB time,aortic cross-clamping time,secondary CPB support,plasma albumin,low ratio of ar terial oxygen tension to inspired oxygen fraction(PaO2/FiO2),mechanical ventilation time,the volume of postoperative drainage per kilogram of body weight,re-intubations,tracheotomy,gastric tube retention,pre vention of stress ulcer.Multivariate logistic regression analysis showed that risk factors included CPB time≥150 min,mechanical veritilation time ≥4 d,the volume of postoperative drainage per kilogram of body weight ≥ 18 ml and tracheotomy.A total of 90 pathogens were obtained by sputum culture in 57 VAP patients.There were 54 cases(60.0％)gram negative bacilli,32 cases(35.6％)of gram positive bacilli and 4 cases (4.4％)of eumycetes.Conclusion These results suggest that the patients with risk factors described above need more careful and postoperative surveillance and management.

Objective To analyze the risk factors for perioperative mortality in children after total correction of tetralogy of Fallot (TOF),in order to provide better operation and decrease the mortality rate.Methods We enrolled 191 TOF patients including 142 males and 49 females at Chengdu Cardiovascular Hospital between Jan 2003 and Dec 2010.The age ranged from 4 months to 12 years.Preoperative,perioperative and postoperative clinical data of all patients were corrected and the risk factors for mortality after total correction of TOF were analyzed.Results Among all the 191 cases,6 cases death (3.14％) occurred in early postoperative,the main causes of death were postoperative infection with multiple organ failure (3 cases),low cardiac output syndrome (2 cases),cerebral complications (1 cases).Among them,2 children (6.67％,2/30) died in age≤6 months,1 child (1.41％,1/71)died in age ranged from 6 months to 3 years,3 children (3.33％,3/90) died in age ranged from 3 years to 12 years.The results of logistic regression and model selection indicated that age ≤ 6 months (OR =4.606,95 ％ CI 1.811 ～ 11.719,P ＜ 0.05),percutaneous oxygen saturation ＜ 70％ before operation (OR =0.982,95％ CI 0.501 ～ 1.932,P ＜ 0.01),Nakata index ＜140 mm2/m2(OR =16.960,95％ CI 1.414 ～ 150.390,P ＜ 0.01),cardiopulmonary bypass time ＞ 150 min (OR =4.398,95 ％ CI 2.091 ～ 9.216,P ＜ 0.01) and multiple organ failure (OR =4.872,95 ％ CI 2.583 ～9.192,P ＜0.05)were risk factors for early postoperative death after total correction of TOF.Conclusion Postoperative mortality in children after total correction of TOF can be predicted by risk factors of age,percutaneous oxygen saturation,Nakata index,cardiopulmonary bypass time,and multiple organ failure.

Objective To evaluate the effects of inhaled nitric oxide(INO) in the early period after Fontan operation. Methods Twenty children receiving INO [(10 ～ 25) × 10 -6] after fight heart bypass for congenital heart disease were evaluated. The changes of hemodynamic and respiratory parameters were observed at two different intervals. The levels of methemoglobin (MetHb)and nitrogen dioxide(NO2)were monitored. Results In INO therapy group,CVP decreased from (20.8±4.8) mm Hg to (14.3±1.8) mm Hg,TPG decreased from (16.3 ±3.0) mm Hg to (8.8±2. 1) mm Hg,PaO2/FiO2 increased from (70.3±16.9) mm Hg to (120.5 ±14.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 91 ±0. 09 ,blood lactic acid level decreased from (3.98 ± 0. 86) mmol/L to (1.29 ± 1.60) mmol/L. No toxic side effect was observed. Conclusion INO has no significant long-term effect on patients after Fontan operation, but it can improve respiratory function, and reduce the incidence of low cardiac output syndrome and high cava pressure caused by reactive elevation of pulmonary vascular resistance in the early postoperative period after Fontan operation.

Objective To evaluate the effects of inhaled nitric oxide (iNO) in management of postoperative pulmonary hypertension in the patients with congenital heart disease. Methods Thirty-two children with refractory pulmonary hypertension or pulmonary hypertensive crisis after open heart operations for congenital heart disease were treated with iNO. The changes of hemodynamics were observed. Results In iNO therapy group,the mean pulmonary artery pressure(mPAP) decreased from (38.0 ±3.2) mm Hg to (28.0 ±2.1) mm Hg,pulmonary vascular resistance (PVR) decreased from (62.2 ±6.7) kPa/(L·S) to (49.9 ±5.6) kPa/(L·S) ,PaO2/FiO2increased from (67.0 ±30. 1 ) mm Hg to (92. 6 ±25.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 84 ±0. 09 respectively. No toxic side effect was observed.Conclusion iNO is effective, safe to reduce pulmonary hypertension. It may play an important role in the treatment of postoperative pulmonary hypertension or pulmonary hypertensive crisis in the patients with congenital heart disease.

Objective To analyze the risk factors associated with multiple organ dysfunction syndrome (MODS) in children after cardiopulmonary bypass (CPB).Methods Between Jan 2001 and Dec 2010,1 899 patients undergoing open heart surgery were reviewed retrospectively according to the presence or absence of MODS.Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results Thirty-five patients (1.84％) developed MODS,the mortality for MODS was 51.43％ (18/35).Univariate risk factors included complex congenital heart disease,perioperative unexpected events,CPB time,aortic cross-clamping time,mechanical ventilation time,and postoperative spsis.Multivariate logistic regression analysis identified that complex congenital heart disease,perioperative unexpected events,CPB time ＞ 180 min,postoperative spsis were risk factors.Conclusion The results suggest that the patients with MODS risk factors described above need more careful peri and post operative surveillance and preventive management.