液体超负荷对婴儿先天性心脏病术后治疗结局的影响

摘要

目的 探讨液体超负荷在婴儿先天性心脏病术后影响及原因分析.方法 收集2012年4月至2016年4月南昌大学附属长城医院ICU收治的176例年龄小于6个月行先天性心脏病根治术后的婴儿临床资料进行回顾性研究.心脏术后采用相同综合治疗策略,记录术后连续7天累积超负荷液体值及临床结局,ROC曲线分析术后液体超负荷最大预测截点值,比较住院病死率,次要比较终点为低心排血量综合征、机械通气时间、ICU停留时间和住院时间,寻找液体超负荷的影响因素.结果 176例患儿纳入研究,ROC曲线分线结果显示液体超负荷术后第2天7.8％截点值(AUC=0.69)具有最大预测价值.液体超负荷大于7.8％较小于7.8％病死率及住院时间无明显差异,低心排血量综合征发生率更高,机械通气、ICU停留时间更长.Logistic回归多变量分析术后不良结局与术后低心排血量综合征及血清肌酐峰值相关(P＜0.05),术后第2天液体超负荷与术后急性肾损伤及低心排血量综合征有关(P＜0.05).结论 先天性心脏病婴儿术后不良结局与血清肌酐峰值及低心排血量综合征有关;术后急性肾损伤和低心排血量综合征是造成液体超负荷的主要原因;缩短体外循环时间,将术后第2天积液体超负荷保持在7.8％以下有助于降低术后相关并发症.%Objective To explore effects and cause of fluid overload on infant following cardiac surgery.Methods This is a single center,(ICU,the Great Wall Affiliated Hospital of Nanchang University)retrospective study,between April 2012 and April 2016,176 infants who aged less than 6 months undergoing pediatric cardiac surgery were included.During consecutive postoperative 7 days,comprehensive treatment strategy for infants following cardiac surgery was adopted,collecting clinical outcomes and calculating data of fluid overload;ROC curve analysising postoperative optimal cutoff value of fluid overload.Hospitalization mortality and the second clinical outcome including low cardiac output syndrome,days on mechanical ventilation,ICU length of stay and hospital length of stay were compared to find risk factors of fluid overload.Results 176 cases of infants included in the study.ROC curves for postoperative seven consecutive days time point of Fo determined the optimal cutoff values of 7.8 ％ for FO (A UC =0.69).The mortality and hospital length of stay is not significant difference between fluid overload above 7.8％ and below or equal to 7.8％,however,the incidence of low cardiac output syndrome was higher in infants with fluid overload above 7.8％,and longer duration of mechanical ventilation,ICU residence time.After multivariable analysis,the postoperative adverse outcomes was associated with low cardiac output syndrome and peak serum creatinine (P ＜ 0.05),and cumulative higher fluid overload on the second day after surgery was associated with postoperative acute kidney injury and low cardiac output syndrome(P ＜ 0.05,respectively).Conclusion Postoperative adverse outcomes in infants with congenital heart disease are associated with peak serum creatinine and low cardiac output syndrome;postoperative acute kidney injury and low cardiac output syndrome are the main causes of fluid overload.Shortening cardiopulmonary bypass time and maintaining fluid overload of postoperative day 2 below 7.8％ will help to the postoperative complications.