目的 探讨小儿法洛四联症根治术后机械通气时间延长的风险因素,并构建列线图.方法 将2021-02/2023-01月在作者医院接受四联症矫正术治疗的117例法洛四联症患儿纳入本研究,根据术后是否发生机械通气时间延长分为延长组(n=29)和非延长组(n=88).收集患儿临床资料,经单因素及多因素Logistic回归分析探讨法洛四联症根治术后机械通气时间延长的影响因素;绘制预测机械通气时间延长的列线图,并采用受试者工作特征(receiver operat-ing characteristic curve,ROC)曲线评估列线图的预测价值.结果 117例患儿行法洛四联症根治术后共有29例(24.79％)发生机械通气时间延长.延长组患儿体质量、身高、血氧饱和度(oxygen saturation,SpO2)小于非延长组,有体肺动脉侧枝占比、有肺动脉狭窄占比、McGoon比值＜1.5占比、C-反应蛋白(C-reactive protein,CRP)水平、体外循环时间、有再次插管占比、重症加强护理病房(intensive care unit,ICU)滞留时间、住院天数大于非延长组(P均＜0.05).多因素 Logistic 回归分析显示,体质量＜9.68 kg[OR=2.063,95％置信区间(confidence interval,CI):1.461～2.912]、有体肺动脉侧枝(OR=2.646,95％CI:1.743～4.017)、McGoon 比值＜1.5(OR=2.259,95％CI:1.545～3.304)、术前 SpO2＜94％(OR=2.790,95％CI:1.827～4.260)、体外循环时间≥113 min(OR=3.435,95％CI:2.113～5.585)是法洛四联症根治术后患儿机械通气时间延长的危险因素(P＜0.05).构建预测小儿法洛四联症根治术后机械通气时间延长的列线图,C-index为0.746(95％CI:0.694～0.789).ROC曲线对小儿法洛四联症根治术后机械通气时间延长列线图的预测价值结果显示,曲线下面积(area under the curve,AUC)为0.768,特异度为71.24％,灵敏度为77.49％(Z=10.237,P＜0.05).结论 基于体质量、体肺动脉侧枝、McGoon比值、术前SpO2、体外循环时间构建的列线图对小儿法洛四联症根治术后机械通气时间延长的发生风险具有较高的预测价值.
Risk Factors for Prolonged Mechanical Ventilation After Repaired Tetralogy of Fallot in Children and Construction of the No-mogram
Objective To explore the risk factors for prolonged mechanical ventilation after repaired Tetralogy of Fallot in children and construct the nomogram.Methods A total of 117 children with Tetralogy of Fallot who received corrective procedure of Tetralogy in author's hospital from February 2021 to January 2023 were selected in this study,and children were divided into prolonged group(n=29)and non-prolonged group(n=88)according to whether mechanical ventilation was prolonged after surgery.The clinical data of the children were collected,and the influencing factors of prolonged mechanical ventilation after radical treatment of Tetralogy of Fallot were investigated by univariate and multiva-riate Logistic regression analysis;the nomogram was drawn to predict prolonged mechanical ventilationa,and the predic-tive value of the line graph for predicting mechanical ventilation duration extension were evaluated by receiver operating characteristic curve(ROC)curve.Results Mechanical ventilation duration prolonged in 29 cases(24.79％)of 117 chil-dren with repaired Tetralogy of Fallot.The body mass,height and oxygen saturation(SpO2)of the children in the pro-longed group were less than those in the non-prolonged group,and the proportion of systemic pulmonary artery collater-als,the proportion of pulmonary artery stenosis,the proportion of McGoon ratio＜1.5,C-reactive protein(CRP)level,the duration of extracorporeal circulation,the proportion of re-intubation,the length of intensive care unit(ICU)stay and the length of hospitalization were higher than those in the non-prolonged group(all P＜0.05).Multivariate Logistic regression analysis showed that body mass＜9.68 kg[OR=2.063.95％confidence interval(CI):1.461-2.912],systemic pulmonary artery collaterals(OR=2.646,95％CI:1.743-4.017),McGoon ratio＜1.5(OR=2.259,95％CI:1.545-3.304),preoperative SpO2＜94％(OR=2.790,95％CI:1.827-4.260)and the dura-tion of extracorporeal circulation ≥113 min(OR=3.435.95％CI:2.113-5.585)were the risk factors for prolonged mechanical ventilation after repaired Tetralogy of Fallot in children(P＜0.05).Prediction of nomogram of prolonged me-chanical ventilation after repaired Tetralogy of Fallot in children was constructed,the C-index was 0.746(95％CI:0.694-0.789).The predictive value of ROC curve on nomogram of prolonged mechanical ventilation after repaired Tetralogy of Fallot in children showed that the area under the curve(AUC)was 0.768,the specificity was 71.24％and the sensi-tivity was 77.49％(Z=10.237,P＜0.05).Conclusion The nomogram based on body mass,systemic pulmonary artery collaterals,McGoon ratio,preoperative SpO2 and the duration of extracorporeal circulation has a high predictive value for the risk of prolonged mechanical ventilation after repaired Tetralogy of Fallot in children.
Tetralogy of FallotDuration of mechanical ventilationRisk factorNomogram
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