All authors: Department of Pediatrics, Royal Brompton Hospital NHS Foundation Trust, London, United Kingdom.
Pediatr Crit Care Med. 2014 Jan;15(1):35-41. doi: 10.1097/PCC.0000000000000004.
To evaluate the impact of Down syndrome on the early postoperative outcomes of children undergoing complete atrioventricular septal defect repair.
Retrospective cohort study.
Single tertiary pediatric cardiac center.
All children admitted to PICU following biventricular surgical repair of complete atrioventricular septal defect from January 2004 to December 2009.
None.
A total of 107 children, 67 with Down syndrome, were included. Children with Down syndrome were operated earlier: 4 months (interquartile range, 3.5-6.6) versus 5.7 months (3-8.4) for Down syndrome and non-Down syndrome groups, respectively (p < 0.01). There was no early postoperative mortality. There was no significant difference in the prevalence of dysplastic atrioventricular valve between the two groups. Two children (2.9%) from Down syndrome and three children (7.5%) from non-Down syndrome group required early reoperation (p = 0.3). Junctional ectopic tachycardia was the most common arrhythmia, and the prevalence of junctional ectopic tachycardia was similar between the two groups (9% and 10% in Down syndrome and non-Down syndrome, respectively, p = 1). One patient from each group required insertion of permanent pacemaker for complete heart block. Children with Down syndrome had significantly higher prevalence of noncardiac complications, that is, pneumothorax, pleural effusions, and infections (p < 0.01), than children without Down syndrome. There was a trend for longer duration of mechanical ventilation in children with Down syndrome (41 hr [20-61 hr] vs 27.5 hr [15-62 hr], p = 0.2). However, there was no difference in duration of PICU stay between the two groups (2 d [1.3-3 d] vs 2 d [1-3 d], p = 0.9, respectively).
In our study, we found no difference in the prevalence of atrioventricular valve dysplasia between children with and without Down syndrome undergoing complete atrioventricular septal defect repair. This finding contrasts with previously published data, and further confirmatory studies are required. Although clinical outcomes were similar, children with Down syndrome had a significantly higher prevalence of noncardiac complications in the early postoperative period than children without Down syndrome.
评估唐氏综合征对行完全房室间隔缺损修复术儿童术后早期结局的影响。
回顾性队列研究。
单中心三级儿科心脏中心。
2004 年 1 月至 2009 年 12 月期间在重症监护病房接受双心室手术修复完全房室间隔缺损的所有患儿。
无。
共纳入 107 例患儿，其中 67 例为唐氏综合征患儿。唐氏综合征患儿的手术时间更早：4 个月（四分位距，3.5-6.6），而非唐氏综合征患儿为 5.7 个月（3-8.4）（p＜0.01）。两组均无早期术后死亡病例。两组患儿的房室瓣发育不良的发生率无显著差异。唐氏综合征组有 2 例（2.9%）患儿和非唐氏综合征组有 3 例（7.5%）患儿需早期再次手术（p=0.3）。交界性异位心动过速是最常见的心律失常，两组交界性异位心动过速的发生率相似（唐氏综合征组 9%，非唐氏综合征组 10%，p=1）。两组各有 1 例患儿因完全性心脏传导阻滞需植入永久性起搏器。唐氏综合征患儿的非心脏并发症（气胸、胸腔积液和感染）发生率明显高于非唐氏综合征患儿（p＜0.01）。唐氏综合征患儿的机械通气时间有延长趋势（41 小时[20-61 小时] vs 27.5 小时[15-62 小时]，p=0.2）。然而，两组患儿的重症监护病房住院时间无差异（2 天[1.3-3 天] vs 2 天[1-3 天]，p=0.9）。
在本研究中，我们发现行完全房室间隔缺损修复术的唐氏综合征患儿和非唐氏综合征患儿的房室瓣发育不良发生率无差异。这一发现与之前发表的数据不同，需要进一步的验证性研究。尽管临床结局相似，但唐氏综合征患儿在术后早期非心脏并发症的发生率明显高于非唐氏综合征患儿。
