摘要目的 探讨影响快速二期大动脉转位术早期死亡的危险因素.方法 回顾性研究2002年9月至2007年9月期间,21例快速二期大动脉转位术病婴临床资料.采用Logistic多元线形回归分析模型对病婴的人口统计学资料,术前诊断资料,左心功能锻炼期资料,以及二期大动脉转位术术中和术后数据进行统计分析,探讨影响快速二期大动脉转位术的危险因素.结果 该手术初期死亡率较高,呈逐年下降趋势.与左心功能锻炼术后死亡相关的为B-T分流自径(P=0.003);与快速二期大动脉转位术后死亡相关的为女性(P=0.006)和术前pLV/RV(P＜0.001).结论 快速二期大动脉转位术是目前治疗错过最佳手术时机的室隔完整型D-TGA病婴的最佳手术方式;使已退化的左心功能得到足够锻炼,是决定二期大动脉转位术成功的关键所在.

abstractsObjective To investigate the risk factors associated with early mortality of the rapid two-stage arerial switch operation, which has a significantly higher overall mortality than that of ASO procedure for D-TGA with a intact ventricular septun. Methods The data we reviewed involving patients who underwent rapid two-stage switch operations from September,2002 to September, 2007 in our center, 13 patients were male and 8 were female, their age at operation ranged from 29 to 250 days afer birth, and the body weight was 3.5 to 7 kg. Chi-squared test and multivariant logistic regression methods were used for the analysis of demographic data, pre-diagnosis information, operation data, interval data combined with the operation time,left ventricle training condition, and the early post-operative outcomes. Results The operative mortality was high at initial stage, and then decreased gradually. The logistic multivariant regression analysis indicated that the mortality of left ventricular training operation was associated with the diameters of BT shunt ( P =0.003 ); the mortality of two-stage switch was associated with feminie ( P = 0.006 ) and pre-operative p. LV/RV ( P ＜ 0.001 ). Conclusion Patients with transposition of the great arteries and intact ventricular septum who missed the optimal time for switch operation should receive rapid two-stage switch operations, which provide an opportunity for the correction of the deformity. The key factor associated with the success for operation was good in heart function after left ventricular training.