先天性心脏病患儿术后低心排血量综合征的危险因素：一项系统评价和荟萃分析。
Risk factors of postoperative low cardiac output syndrome in children with congenital heart disease: A systematic review and meta-analysis.
作者信息
Wang Peiying, Fu Cangcang, Bai Guannan, Cuan Linbo, Tang Xiaomin, Jin Chendi, Jin Hongchong, Zhu Jihua, Xie Chunhong
机构信息
Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
出版信息
Front Pediatr. 2023 Jan 10;10:954427. doi: 10.3389/fped.2022.954427. eCollection 2022.
BACKGROUND
Low cardiac output syndrome (LCOS) is the most common complication after cardiac surgery, which is associated with the extension of postoperative hospital stay and postoperative death in children with congenital heart disease (CHD). Although there are some studies on the risk factors of LCOS in children with CHD, an unified conclusion is lack at present.
PURPOSES
To synthesize the risk factors of LCOS after CHD in children, and to provide evidence-based insights into the early identification and early intervention of LCOS.
METHODS
The databases of the China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), PubMed, Cochrane Library, Embase and Web of Science were searched for relevant articles that were published between the establishing time of each database and January 2022. Based on retrospective records or cohort studies, the influencing factors of postoperative low cardiac output in children with congenital heart disease were included in Meta analysis.This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was evaluated according to the Newcastle-Ottawa Scale (NOS). RevMan 5.4 software was used to conduct the meta-analysis.
RESULTS
A total of 1,886 records were screened, of which 18 were included in the final review. In total, 37 risk factors were identified in the systematic review. Meta- analysis showed that age, type of CHD, cardiac reoperation, biventricular shunt before operation, CPB duration, ACC duration, postoperative residual shunt, cTn-1 level 2 h after CPB > 14 ng/ml and postoperative 24 h MR-ProADM level > 1.5 nmol/l were independent risk factors of LCOS. Additionally, the level of blood oxygen saturation before the operation was found to have no statistically significant relationship with LOCS.
CONCLUSION
The risk factors of postoperative LCOS in children with CHD are related to disease condition, intraoperative time and postoperative related indexes, so early prevention should be aimed at high-risk children.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier: CRD42022323043.
背景
低心排血量综合征（LCOS）是心脏手术后最常见的并发症，与先天性心脏病（CHD）患儿术后住院时间延长及术后死亡相关。虽然有一些关于CHD患儿LCOS危险因素的研究，但目前尚无统一结论。
目的
综合分析CHD患儿术后LCOS的危险因素，为LCOS的早期识别和早期干预提供循证依据。
方法
检索中国知网（CNKI）、万方数据库、维普中文科技期刊数据库（VIP）、PubMed、Cochrane图书馆、Embase和Web of Science数据库，查找各数据库建库至2022年1月期间发表的相关文章。纳入基于回顾性记录或队列研究的先天性心脏病患儿术后低心排血量影响因素进行Meta分析。本研究遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。根据纽卡斯尔-渥太华量表（NOS）评估偏倚风险。使用RevMan 5.4软件进行Meta分析。
结果
共筛选出1886条记录，其中18条纳入最终综述。系统评价共识别出37个危险因素。Meta分析显示，年龄、CHD类型、再次心脏手术、术前双心室分流、体外循环（CPB）时间、主动脉阻断（ACC）时间、术后残余分流、CPB后2小时肌钙蛋白I（cTn-1）水平>14 ng/ml及术后24小时中段心房利钠肽前体（MR-ProADM）水平>1.5 nmol/l是LCOS的独立危险因素。此外，术前血氧饱和度水平与LCOS无统计学显著相关性。
结论
CHD患儿术后LCOS的危险因素与病情、术中时间及术后相关指标有关，因此应针对高危患儿进行早期预防。
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