MATURATIONAL AND HEMODYNAMIC FACTORS PREDICTIVE OF INCREASED CYANOSIS AFTER BIDIRECTIONAL CAVOPULMONARY ANASTOMOSIS
MATURATIONAL AND HEMODYNAMIC FACTORS PREDICTIVE OF INCREASED CYANOSIS AFTER BIDIRECTIONAL CAVOPULMONARY ANASTOMOSIS
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DOI：
10.1016/0002-9149(94)90314-x
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发表时间：
1994-10-01
影响因子：
2.8
通讯作者：
BRIDGES, ND
中科院分区：
文献类型：
--
作者：
GROSS, GJ;JONAS, RA;BRIDGES, ND
双向腔隙肺吻合术（BCA）被认为有利于缓解被认为是Fontan修复高风险的单室先天性心脏病患者。接受BCA的患者的经验表明，那些在手术时年龄较大或体型较大的患者术后往往比年龄较小和体型较小的患者更加青紫。本研究旨在确定BCA后全身动脉氧饱和度的相关因素。具体来说，假设血液分布的成熟变化可能与动脉氧饱和度的降低有关。我们回顾了1988年6月至1991年底在我院接受BCA的110例患者的数据库记录。66例患者可获得术后置管数据。21例患者被排除在外，因为他们有可能可逆的紫绀原因，在血流动力学计算中产生不可估量的误差。在其余45例患者中，采用单因素和多因素回归分析来确定全身动脉氧饱和度的相关因素。体表面积代表的生长和成熟与动脉血氧饱和度呈高度显著的负相关（p = 0.005），肺血管阻力也是如此（p = 0.003）。接受BCR的患者在>3.9岁或体表面积>0.65 m(2)时发生术后过度紫绀的风险显著增加，紫绀的定义为全身动脉氧饱和度小于或等于75% (p
Bidirectional cavopulmonary anastomosis (BCA) is thought to be beneficial in the palliation of patients with univentricular congenital heart disease considered at high risk for Fontan repair. Experience with patients undergoing BCA suggested that those who were older or larger at the time of surgery tended to be more cyanotic postoperatively than their younger and smaller counterparts. This study was designed to identify correlates of systemic arterial oxygen saturation after BCA. Specifically, it was postulated that maturational changes in blood now distribution might be associated with decreasing arterial oxygen saturation. Database records of all 110 patients undergoing BCA at our institution from June 1988 until the end of 1991 were reviewed. Postoperative catheterization data were available for 66 patients. Twenty-one patients were excluded because they had potentially reversible causes of cyanosis yielding inestimable degrees of error in hemodynamic calculations. In the remaining 45 patients, univariate and multivariate regression analyses were used to identify correlates of systemic arterial oxygen saturation. Growth and maturation as represented by body surface area exhibited a highly significant inverse correlation with arterial oxygen saturation (p = 0.005), as did pulmonary vascular resistance (p = 0.003). Patients who underwent BCR when >3.9 years of age or with body surface area >0.65 m(2) were at significantly increased risk for excessive postoperative cyanosis, defined as systemic arterial oxygen saturation less than or equal to 75% (p