Tóth Roland, Szántó Péter, Prodán Zsolt, Lex Daniel J, Sápi Erzsébet, Szatmári András, Gál János, Szántó Tamás, Székely Andrea
School of Doctoral Studies, Semmelweis University, Budapest, Hungary.
Interact Cardiovasc Thorac Surg. 2013 Oct;17(4):691-7. doi: 10.1093/icvts/ivt267. Epub 2013 Jul 5.
The incidence of congenital heart disease is ~50%, mostly related to endocardial cushion defects. The aim of our study was to investigate the postoperative complications that occur after paediatric cardiac surgery.
Our perioperative data were analysed in paediatric patients with Down syndrome undergoing cardiac surgery. We retrospectively analysed the data from 2063 consecutive paediatric patients between January 2003 and December 2008. After excluding the patients who died or had missing data, the analysed database (before propensity matching) contained 129 Down patients and 1667 non-Down patients. After propensity matching, the study population comprised 222 patients and 111 patients had Down syndrome.
Before propensity matching, the occurrences of low output syndrome (21.2 vs 32.6%, P = 0.003), pulmonary complication (14 vs 28.7%, P < 0.001) and severe infection (11.9 vs 22.5%, P = 0.001) were higher in the Down group. Down patients were more likely to have prolonged mechanical ventilation [median (interquartile range) 22 (9-72) h vs 49 (24-117) h, P = 0.007]. The total intensive care unit length of stay [6.9 (4.2-12.4) days vs 8.3 (5.3-13.2) days, P = 0.04] and the total hospital length of stay [17.3 (13.3-23.2) days vs 18.3 (15.1-23.6) days, P = 0.05] of the Down patients were also longer. Mortality was similar in the two groups before (3.58 vs 3.88%, P = 0.86) and after (5.4 vs 4.5%, P = 1.00) propensity matching. After propensity matching, there was no difference in the occurrence of adverse events.
After propensity matching Down syndrome was not associated with increased mortality or complication rate following congenital cardiac surgery.
先天性心脏病的发病率约为50%，大多与心内膜垫缺损有关。我们研究的目的是调查小儿心脏手术后出现的术后并发症。
我们分析了接受心脏手术的唐氏综合征小儿患者的围手术期数据。我们回顾性分析了2003年1月至2008年12月期间连续的2063例小儿患者的数据。在排除死亡或有缺失数据的患者后，分析的数据库（倾向匹配前）包含129例唐氏患者和1667例非唐氏患者。倾向匹配后，研究人群包括222例患者，其中111例患有唐氏综合征。
在倾向匹配前，唐氏组低心排综合征的发生率（21.2%对32.6%，P = 0.003）、肺部并发症（14%对28.7%，P < 0.001）和严重感染（11.9%对22.5%，P = 0.001）更高。唐氏患者更有可能需要延长机械通气时间[中位数（四分位间距）22（9 - 72）小时对49（24 - 117）小时，P = 0.007]。唐氏患者在重症监护病房的总住院时间[6.9（4.2 - 12.4）天对8.3（5.3 - 13.2）天，P = 0.04]以及总住院时间[17.3（13.3 - 23.2）天对18.3（15.1 - 23.6）天，P = 0.05]也更长。在倾向匹配前（3.58%对3.88%，P = 弥合分裂0.86）和倾向匹配后（5.4%对4.5%，P = 1.00），两组的死亡率相似。倾向匹配后，不良事件的发生率没有差异。
倾向匹配后，唐氏综合征与先天性心脏手术后死亡率或并发症发生率的增加无关。
