Murni Indah K, Djer Mulyadi M, Yanuarso Piprim B, Putra Sukman T, Advani Najib, Rachmat Jusuf, Perdana Aries, Sukardi Rubiana
Department of Pediatrics, Faculty of Medicine, Dr. Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Department of Child Health, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
Ann Pediatr Cardiol. 2019 Jan-Apr;12(1):38-44. doi: 10.4103/apc.APC_146_17.
Evaluating outcome and identifying predictors of major complications among children undergoing cardiac surgery are essential to improve care. We evaluated short-term outcomes of postcardiac surgery and predictors of major complications in a national referral hospital in Indonesia.
A prospective cohort study was conducted from April 2014 to March 2015 on all children undergoing cardiac surgery. Participants were followed up from the time of surgery until hospital discharge and 30-day mortality. We performed univariate and multivariate logistic regression using STATA 12-1 to identify predictors of postsurgical major complications.
A total of 257 patients (median age: 36 months) were recruited; 217 (84.1%) had complications, including low cardiac output syndrome (19.8%), arrhythmia (18.6%), sepsis (17.4%), and pleural effusion (14.8%). Forty-nine (19%) patients had major complications, including cardiac arrest (5%), need for emergency chest opening (3.9%), and multiple organ failure (7.4%). 12.8% died during hospital stay, and 30-day mortality was 13.6%. Predictors of major complications were cyanotic congenital heart disease (odds ratio [OR]: 4.6, 95% confidence interval [CI]: 1.5-14.2), longer duration of cardiopulmonary bypass (CPB, OR: 4.4, 95% CI: 1.5-13.4), high inotropes (OR: 13.1, 95% CI: 3.2-54.2), and increase in lactate >0.75 mmol/L/h or more in the first 24 h (OR: 37.1, 95% CI: 10.1-136.3).
One-fifth of children undergoing cardiac surgery experienced major complications with around 13% mortality. Cyanotic congenital heart disease, longer duration of CPB, high inotropes on leaving operating theater, and increase in blood lactate are associated with major complications in children after cardiac surgery.
评估接受心脏手术儿童的预后并确定主要并发症的预测因素对于改善治疗至关重要。我们在印度尼西亚的一家国家转诊医院评估了心脏手术后的短期预后及主要并发症的预测因素。
2014年4月至2015年3月，对所有接受心脏手术的儿童进行了一项前瞻性队列研究。从手术时起对参与者进行随访，直至出院及30天死亡率。我们使用STATA 12 - 1进行单变量和多变量逻辑回归，以确定术后主要并发症的预测因素。
共招募了257例患者（中位年龄：36个月）；217例（84.1%）出现并发症，包括低心排血量综合征（19.8%）、心律失常（18.6%）、脓毒症（17.4%）和胸腔积液（14.8%）。49例（19%）患者出现主要并发症，包括心脏骤停（5%）、需要紧急开胸（3.9%）和多器官功能衰竭（7.4%）。12.8%的患者在住院期间死亡，30天死亡率为13.6%。主要并发症的预测因素为青紫型先天性心脏病（比值比[OR]：4.6，95%置信区间[CI]：1.5 - 14.2）、体外循环（CPB）时间延长（OR：4.4，95% CI：1.5 - 13.4）、高剂量血管活性药物（OR：13.1，95% CI：3.2 - 54.2）以及术后24小时内乳酸升高>0.75 mmol/L/小时或更高（OR：37.1，95% CI：10.1 - 136.3）。
五分之一接受心脏手术的儿童出现主要并发症，死亡率约为13%。青紫型先天性心脏病、体外循环时间延长、术后离开手术室时使用高剂量血管活性药物以及血乳酸升高与儿童心脏手术后的主要并发症相关。
