摘要目的 分析影响婴幼儿先天性心脏病术后撤机失败的危险因素.方法 收集2015年1月至2016年10月在中山大学附属第一医院体外循环下行先天性心脏病手术婴幼儿的临床及实验室资料,包括患儿年龄、性别、体质量、先天性心脏病类型、体外循环时间、术后血管活性药物使用等.根据呼吸机撤离失败与否分为撤机失败组和撤机成功组.结果 共收集先天性心脏病术后婴幼儿病例60例.其中撤机失败组12例,男7例,女5例,男女比例为1.4∶1.0;平均年龄0.56岁,其中＜3个月3例(25.0％),3～6个月5例(41.6％);体质量≤5 kg者8例(66.7％),＞5～10 kg者4例(33.3％).撤机成功组48例,男27例,女21例,男女比例为1.2∶1.0;平均年龄1.15岁.撤机失败组年龄及体质量均较撤机成功组低[(0.42(0.37)岁比1.00(1.08)岁,Z=-3.22,P＜0.01;5.00(1.25) kg比8.40(3.95) kg,Z=-3.57,P＜0.01].2组患儿体外循环时间、首次呼吸机使用时间比较差异均有统计学意义[114.0(110.0)min比80.0(45.0) min,Z=1.59,P＜0.05;142.5(229.5)h比14.0(48.9)h,Z=2.00,P＜0.05];2组患儿撤机后呼吸道痉挛、肺部感染情况比较差异均无统计学意义(x2=4.00、5.54,均P>0.05).多因素Logistic回归结果显示,体外循环时间是影响婴幼儿术后撤机失败的独立危险因素[优势化(OR)=0.967,95％ CI:0.956 ～0.997,P =0.024].结论 年龄小、体质量低、呼吸机使用时间长及体外循环时间长为婴幼儿先天性心脏病术后撤机失败的危险因素.体外循环时间是影响婴幼儿先天性心脏病术后撤机失败的独立危险因素.

abstractsObjective To investigate the risk factors of extubation failure following surgical repair of congenital heart defects (CHD) in infants.Methods Infantile patients who underwent surgical repair of CHD under cardiopulmonary bypass (CPB) in the First Affiliated Hospital of Sun Yat-Sen University from January 2015 to October 2016 were included.According to results of extubation,the patients were divided into the extubation failure group and extubation success group.Clinical and laboratory data were collected and analyzed,including age,gender,body mass,the types of congenital heart disease,extracorporeal circulation time and the use of vasoactive drug,et al.Results Sixty cases were enrolled in this study.Among them 12 cases (7 males,5 females with the boy to girl ratio of 1.4 ∶ 1.0,and average age was 0.56 years old) were in the extubation failure group,in which 3 cases (25.0％)aged ＜3 months,5 cases(41.6％) aged 3-6 months.Eight cases(66.7％) weighed ≤5 kg and 4 cases(33.3％)weighed ＞ 5-10 kg.Forty-eight cases (27 males,21 females;the boy to girl ratio was 1.2 ∶ 1.0 and average age was 1.15 years old) were in the extubation success group.The distribution of age and body weight were significantly lower in the extubation failure group than those in the extubation success group [0.42 (0.37) years old vs.1.00 (1.08)years old,Z=-3.22,P＜0.01;5.00 (1.25) kgvs.8.40 (3.95) kg,Z=-3.57,P＜0.01].The durations of CPB and mechanical ventilation until the initial extubation were significantly longer in the extubation failure group than those in the extubation group [114.0 (110.O) minutes vs.80.0 (45.0) minutes,Z =1.59,P ＜ 0.05;142.5 (229.5)hours vs.14.0 (48.9) hours,Z =2.00,P ＜ 0.05].The incidences of airway spasm and pulmonary infection had no difference between the 2 groups (x2 =4.00,5.54,all P ＞ 0.05).Multiple Logistic regression showed thatthe duration of CPB was an independent risk factor of extubation failure [odds ratio (OR) =0.967,95％ CI:0.956-0.997,P =0.024].Conclusions The risk factors of extubation failure include young age,low body weight,and prolonged CPB and mechanical ventilation.CPB time is an independent risk factor of extubation failure following cardiac surgery in infants.