目的：通过分析完全性心内膜垫缺损（ TECD ）矫治术患儿的围术期基本资料，探究TECD患儿积极早期拔除气管插管（ EE ）的相关危险因素， EE定义为于手术室拔除气管插管或者返回重症监护室（ ICU）后24 h内拔除气管插管。方法回顾性分析2013年1月至2014年12月阜外心血管病医院小儿外科中心收治的TECD矫治术患儿59例，剔除2例床旁开胸、心包引流及1例死亡病例后，将剩余56例按照EE与否分为EE组与非EE组，EE组纳入34例，男15例，女19例，年龄（30畅15±29畅15）个月，体重（13畅73±16畅02）kg；非EE组纳入22例，男9例，女13例，年龄（11畅49±5畅59）个月，体重（7畅94±5畅66）kg；比较EE组与非EE组的围术期基本资料。结果59例患儿术后早期死亡1例（1畅7％），死亡原因为严重房室瓣反流所致心力衰竭及急性呼吸窘迫综合征（ ARDS ）等多器官功能衰竭。 EE组术后呼吸机辅助及ICU时间分别为12畅1 h和2畅6 d，非EE组均明显延长，分别为58畅3 h和7畅1 d。小年龄（ P＝0畅010）、低体重（ P＝0畅025）及术后二尖瓣反流量（ P＜0畅001）是影响TECD患儿早期拔管的主要因素。结论 TECD矫治术后多数患儿可实现早期脱机，小年龄、低体重及术后二尖瓣反流量是影响EE的危险因素，而其中术后二尖瓣反流量是影响EE的独立危险因素，通过危险因素分析建立风险分层的术后管理策略有助于EE的安全实施、帮助重症患儿平稳恢复。%Objective To investigate the risk factors of early extubation ( EE ) in pediatric patients after total endocardial cushion defect ( TECD ) surgery , EE is defined as extubation in the operation room or after the return of intensive care unit ( ICU ) within 24 h.Methods A total of 59 patients underwent TECD repair in the Pediatric Surgery Department of Fuwai Hospital from January 2013 to December 2014, excluding 3 cases, the remaining 56 cases according to EE were divided into EE group and non EE group ,EE group included 34 patients, 15 male and 19 female with their age of (30.15 ±29.15 ) months,weight of (13.73 ±16.02 ) kg;non EE group included 22 patients,9 male and 13 female with their age of(11.49 ±5.59)months,weight of(7.94 ±5.66)kg. Results One patient died postoperatively because of severe atrioventricular valve regurgitation and finally caused heart failure and ARDS .The mechanical ventilation and ICU stay were 12.1 hours and 2.6 days respectively in EE group,which were significantly prolonged in non EE group ( 58.3 h and 7.1 d respectively ) .Small age ( P =0.010),low weight(P=0.025)and postoperative mitral regurgitation (P<0.001)were the main influence factors of early extubation in children after TECD .Conclusions Most patients after TECD repair can achieve early extubation .Small age ,low weight and postoperative mitral regurgitation are the risk factors of EE .
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