Yun Tae-Jin, Im Yu-Mi, Jung Sung-Ho, Jhang Won-Kyoung, Park Jeong-Jun, Seo Dong-Man, Kim Young-Hwue, Park In-Sook, Ko Jae-Kon, Lee Moo-Song
Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan, Republic of Korea.
Int J Cardiol. 2009 Mar 20;133(1):55-61. doi: 10.1016/j.ijcard.2007.11.083. Epub 2008 Feb 19.
Preoperative risk analysis for Fontan candidates is still less than optimal in that patients with apparently low risks may have a poor outcome, such as prolonged pleural drainage, protein-losing enteropathy, pulmonary thromboembolism and death. We hypothesized that low pulmonary vascular compliance (PVC) is a risk factor for persistent pleural effusion after the Fontan operation.
A retrospective review of 85 patients who underwent the extracardiac Fontan procedures (median age: 3.87 years) was performed. Fontan risk score (FRS) was calculated from 12 categorized preoperative anatomical and physiological variables. PVC (mm(2)/m(2) x mmHg) was defined as pulmonary artery index (mm(2)/m(2)) divided by total pulmonary resistance (Wood Unit x m(2)) and pulmonary blood flow (L/min/m(2)), based on the electrical circuit analogy of the pulmonary circulation. Chest tube indwelling time was log-transformed (log indwelling time, LIT) to fit normal distribution, and the relationship between perioperative predictors and LIT was analyzed by multiple linear regression.
Preoperative PVC, chest tube indwelling time and LIT ranged from 6 to 94.8 mm(2)/mmHg/m(2) (median: 24.8), 3 to 268 days (median: 20 days), and 1.1 to 5.6 (mean: 2.9, standard deviation: 0.8), respectively. FRS, PVC, cardiopulmonary bypass time (CPB) and central venous pressure at postoperative 12 h were correlated with LIT by univariable analyses. By multiple linear regression, PVC (p=0.002) and CPB (p=0.003) independently predicted LIT, explaining 22% of the variation. The regression equation was LIT=2.744-0.016 PVC+0.007 CPB.
Low pulmonary vascular compliance is an important risk factor for prolonged pleural effusion drainage after the extracardiac Fontan procedure.
对于Fontan手术候选患者的术前风险分析仍不尽人意，因为表面风险较低的患者可能预后较差，如胸腔引流时间延长、蛋白丢失性肠病、肺血栓栓塞和死亡。我们推测肺血管顺应性（PVC）低是Fontan手术后持续性胸腔积液的一个风险因素。
对85例行心外Fontan手术的患者（中位年龄：3.87岁）进行回顾性研究。Fontan风险评分（FRS）由12个分类的术前解剖和生理变量计算得出。基于肺循环的电路类比，PVC（mm²/m²×mmHg）定义为肺动脉指数（mm²/m²）除以总肺阻力（伍德单位×m²）和肺血流量（L/min/m²）。胸管留置时间进行对数转换（对数留置时间，LIT）以符合正态分布，并通过多元线性回归分析围手术期预测因素与LIT之间的关系。
术前PVC、胸管留置时间和LIT分别为6至94.8mm²/mmHg/m²（中位值：24.8）、3至268天（中位值：20天）和1.1至5.6（均值：2.9，标准差：0.8）。单因素分析显示FRS、PVC、体外循环时间（CPB）和术后12小时中心静脉压与LIT相关。通过多元线性回归，PVC（p = 0.002）和CPB（p = 0.003）独立预测LIT，解释了22%的变异。回归方程为LIT = 2.744 - 0.016PVC + 0.007CPB。
肺血管顺应性低是心外Fontan手术后胸腔积液引流时间延长的重要风险因素。
