婴幼儿先天性心脏病术后早期发热的危险因素分析
Risk factors analysis for early postoperative fever in infants with congenital heart disease
目的 分析引起婴幼儿先天性心脏病术后早期发热的危险因素.方法 收集2014年1月至2015年12月在中山大学附属第一医院行体外循环下先天性心脏病手术的婴幼儿临床及实验室资料,根据术后72 h内是否伴体温>38.5℃分为发热组和非发热组,比较2组患儿年龄、性别、体质量、最高体温、炎性指标、体外循环时间、术前感染、微生物感染、输血及心功能评估等.结果 74例先天性心脏病术后婴幼儿中,发热组53例,占71.6%,男女比例为1.1∶1.0;非发热组21例,占28.4%,男女比例为1.2∶1.0.最常见的先天性心脏病类型包括室间隔缺损45例(60.8%)、法洛四联症5例(6.7%)及房间隔缺损4例(5.4%).发热组患儿术前白细胞计数显著高于非发热组[(10.67±3.15)×109/L比(8.97±2.82)×109/L],差异有统计学意义(t=2.15,P<O.05).发热组患儿术前中性粒细胞计数[2.83 (2.05~ 3.88)×109/L比2.31(1.80~2.89)×109/L]及单核细胞计数[0.75(0.58 ~0.98)×109/L比0.59(0.46 ~0.81)×109/L]显著高于非发热组,差异均有统计学意义(Z=-2.21、-2.26,均P<0.05).2组患儿年龄、术前感染、体外循环时间、性别、术后第1天白细胞计数、心功能评估等比较差异均无统计学意义(均P >0.05).多因素Logistic回归分析显示,术前单核细胞计数是婴幼儿先天性心脏病术后早期发热的独立危险因素(OR=21.275,95%CI 1.84~246.11,P<0.05).结论 先天性心脏病患儿术前白细胞计数与术后早期发热密切相关,且术前单核细胞水平是引起婴幼儿先天性心脏病术后早期发热的独立危险因素.
更多Objective To analyze the risk factors for early postoperative fever in infants with congenital heart disease.Methods The clinical and laboratory data were collected from infants who underwent congenital heart disease surgery under extracorporeal circulation from January 2014 to December 2015 in the First Affiliated Hospital of Sun Yat-Sen University.The patients were divided into a fever group and a non-fever group according to the degree of their temperature > 38.5 ℃ in 72 hours after surgery group.And the age,gender,weight,the highest temperature,inflammation index,extracorporeal circulation time,preoperative infection,microbial infection,blood transfusion and cardiac function evaluation,et al were compared between the 2 groups.Results A total of 74 cases of congenital heart disease in infants were enrolled in this research,among which 53 cases were of fever group,accounting for 71.6%,with the male to female ratio of 1.1 ∶ 1.0;the non-fever group had 21 cases,accounting for 28.4%,with the male to female ratio of 1.2 ∶ 1.0.The most common types of congenital heart disease were ventricular septal defect in 45 cases (60.8 %),5 cases (6.7 %) of tetralogy of fallot and 4 cases (5.4%) of atrial septum defect.The preoperative white blood cell count in the fever group was higher than that of the non-fever group [(10.67 ± 3.15) × 109/L vs.(8.97 ± 2.82) × 109/L,t =2.15,P <0.05].The neutrophils and mononuclear cell count of the fever group were obviously higher than those of the non-fever group[2.83 (2.05-3.88) × 109/L vs.2.31 (1.80-2.89) × 109/L,Z =-2.21,P < 0.05;0.75 (0.58-0.98) × 109/L vs.O.59 (0.46-0.81) × 109/L,Z =-2.26,P < 0.05].There was no significant difference in age,preoperative infection,cycle time,gender,the white blood cell count at the first day postoperative between the 2 groups (all P > 0.05).Multiariable Logistic regression analysis showed that preoperative mononuclear cell count was independent risk factor for the development of early postoperative fever in infants with congenital heart disease (OR =21.275,95 % CI 1.84-246.11,P < 0.05).Conclusions The preoperative white blood cell count is closely associated with early postoperative fever,and the preoperative monocytes count is the independent risk factors for the development of early postoperative fever in infants with congenital heart disease.
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