Aziz Saleha, Ayub Maaha, Masood Laiba, Amanullah Muneer, Hameed Rukhsana, Hashmi Shiraz, Ahmad Waris
Saleha Aziz Medical Student, Aga Khan University, Karachi, Pakistan.
Maaha Ayub Medical Student, Aga Khan University, Karachi, Pakistan.
Pak J Med Sci. 2020 Jul-Aug;36(5):925-929. doi: 10.12669/pjms.36.5.1743.
To compare pre-operative, intra-operative, and post-operative parameters in Down syndrome (DS) and non-DS patients with atrioventricular septal defects (AVSD) and inlet ventricular septal defects (VSD) in a tertiary care hospital in Pakistan.
We conducted a retrospective study at Aga Khan University, Pakistan. All complete atrioventricular septal defect (CAVSD), partial atrioventricular septal defect (PAVSD), and VSD with inlet extension surgical cases from January 2007 to January 2019 were included. Patients with congenital heart diseases other than those listed above were excluded.
In 61 cases, 18 had DS. Median age, mean body surface area (BSA), and height were lower in DS patients compared to non-DS patients: 7.0 vs 23.0 months, 0.311 vs 0.487 m2, and 63 vs 82 cm, respectively. Bypass duration, aortic cross clamp time, post-operative ventilator hours, dose of inotropes, CICU stay, and total hospital stay were all significantly higher in the DS group. The odds ratio (955% CI) for mortality in DS babies was 6.2 (1.4, 27.1), p=0.015, after adjusting for age, weight, and height. The overall morbidity was comparable between the two groups, demonstrating no significant difference after adjusting for confounders.
DS babies with AVSD and inlet VSD are at a greater risk of mortality compared to non-DS babies, particularly those with CAVSD. Furthermore, DS babies undergo surgery at a younger age and require more aggressive post-operative therapy and monitoring due to the development of complications.
在巴基斯坦一家三级医疗中心，比较唐氏综合征（DS）和非DS患者在患有房室间隔缺损（AVSD）和流入道室间隔缺损（VSD）时的术前、术中和术后参数。
我们在巴基斯坦阿迦汗大学进行了一项回顾性研究。纳入了2007年1月至2019年1月期间所有完全性房室间隔缺损（CAVSD）、部分性房室间隔缺损（PAVSD）以及伴有流入道延伸的VSD手术病例。排除患有上述以外先天性心脏病的患者。
61例病例中，18例患有DS。与非DS患者相比，DS患者的中位年龄、平均体表面积（BSA）和身高更低：分别为7.0个月对23.0个月、0.311平方米对0.487平方米、63厘米对82厘米。DS组的体外循环时间、主动脉阻断时间、术后呼吸机使用时长、血管活性药物剂量、心脏重症监护病房（CICU）停留时间和总住院时间均显著更长。在对年龄、体重和身高进行校正后，DS患儿死亡的比值比（95%置信区间）为6.2（1.4，27.1），p = 0.015。两组的总体发病率相当，在对混杂因素进行校正后无显著差异。
与非DS患儿相比，患有AVSD和流入道VSD的DS患儿死亡风险更高，尤其是患有CAVSD的患儿。此外，DS患儿手术年龄更小，由于并发症的发生，术后需要更积极的治疗和监测。
