Torres-Romucho Camilo E, Uriondo-Ore Victor G, Ramirez-Palomino Alberto J, Arroyo-Hernández Hugo, Loo-Valverde Maria, Protzel-Pinedo Ana, Dueñas-Roque Milagros
Facultad de Medicina, Universidad Nacional San Luis Gonzaga. Ica, Perú.
Hospital Nacional Alberto Sabogal Sologuren. Lima, Perú.
Rev Peru Med Exp Salud Publica. 2019 Jul-Sep;36(3):433-441. doi: 10.17843/rpmesp.2019.363.4166. Epub 2019 Dec 2.
OBJECTIVES.: To determine factors associated with survival in the first year of life in neonates with severe congenital heart disease treated in a national hospital in Peru.
MATERIALS AND METHODS.: 160 children born between 2012 and 2015 with a diagnosis of severe congenital cardiopathy were studied and admitted to the Neonatology Service of the Edgardo Rebagliati Martins National Hospital of the Peruvian Social Security. The Kaplan-Meier method and the Log-Rank test were used in the survival analysis. Crude and adjusted analyses were performed using Cox regression models.
RESULTS.: Fifty-two, point 5 percent (52.5%) of patients were male and the most frequent severe congenital cardiopathy was pulmonary atresia (26.3%). Thirty-three, point seven percent (33.7%) of patients died, with a 66.3% (IC95% 58.4-73.0) one-year survival. Prenatal diagnosis improved survival (HRa 0.54, 95% CI 0.30-0.98) while cyanotic cardiopathies (HRa 2.93, 95% CI 1.36-6.34) and the presence of another congenital anomaly (HRa 3.28, 95% CI 1.79-6.01) decreased it; these factors were also significant in a second model stratified by surgical treatment with the exception of the stratified model by complications where a prenatal diagnosis ceased to be significant.
CONCLUSIONS.: Prenatal diagnosis increases survival from severe congenital heart disease. However, cyanotic heart diseases and other congenital anomalies, which decrease this chance, should be considered, if surgery is performed or complications occur.
确定在秘鲁一家国立医院接受治疗的患有严重先天性心脏病的新生儿出生后第一年的生存相关因素。
对2012年至2015年间出生且诊断为严重先天性心脏病的160名儿童进行研究,并收治于秘鲁社会保障局埃德加多·雷瓦利亚蒂·马丁斯国立医院的新生儿科。生存分析采用Kaplan-Meier法和对数秩检验。使用Cox回归模型进行粗分析和校正分析。
52.5%的患者为男性,最常见的严重先天性心脏病是肺动脉闭锁(26.3%)。33.7%的患者死亡,一年生存率为66.3%(95%置信区间58.4 - 73.0)。产前诊断可提高生存率(校正风险比0.54,95%置信区间0.30 - 0.98),而青紫型心脏病(校正风险比2.93,95%置信区间1.36 - 6.34)和存在其他先天性异常(校正风险比3.28,95%置信区间1.79 - 6.01)会降低生存率;在按手术治疗分层的第二个模型中,这些因素也具有显著性,但在按并发症分层的模型中,产前诊断不再具有显著性。
产前诊断可提高严重先天性心脏病的生存率。然而,如果进行手术或出现并发症,应考虑到青紫型心脏病和其他先天性异常会降低这种生存机会。