ABSTRACT
Objective To analyze the blood gas analysis before extubation related to early withdraw venti-lator in infants with congenital heart disease.Methods Collecting the blood gas analysis datas before extubation of infants with congenital heart disease who were treated with CICU in our hospital from 2014. 01.01 to 2017.01.01, To analyze the relationship between early withdraw ventialtor and the blood gas analysis before extubation. Re-sults 1.Univariate analysis showed that infants with congenital heart disease early postoperative rate of weaning were related to blood gas analysis before extubation with PH,HCO3-,Lac-,SaO2,A-aDO2,respiratory index and oxygenation index(P<0.05).2.The results of non conditional logisitic regression analysis showed that PH,HCO3-and Lac- were independent factors,the value of OR(95%CI) were 50.1(80-311),1.51(1.12-2.02) and 0.18 (0.05-0.65). Conclusion In infants with congenital heart disease before extubation SaO2high,A-aDO2≤ 100 mmHg,respiratory index low and oxygenation index high were the important factors of postoperative early weaning;The PH,HCO3-and Lac-were independent factors,even though early withdrawal unit blood gas analysis before ex-tubation the index is inferior to late withdrawal unit's,it can also achieve early weaning in the basic normal value range.
ABSTRACT
Objective To analyze the preoperative related factors of early weaning of infants with congenital heart disease after operation. Methods From January ,2014 to January ,2017 in Pediatric Cardiology CICU , infants with congenital heart disease were selected as research objects. The clinical data were retrospectively collect ed and the relationship between preoperative influencing factors and postoperative early weaning were analyzed. Early weaning meant mechanical ventilation time was shorter than 24 h and late weaning meant longer than 24 h. Results Single factor analysis showed that early weaning success rate was related to preoperative cardiac function grade 1,NNIS grade 0~1,ASA grade 1,no lung infection and no or mild pulmonary hypertension(average P<0.05). Non conditional logistic regression analysis showed that preoperative heart function grade 1 was an indepen-dent influencing factor,with OR value(95%CI)of 3.9(1.9~7.7). Conclusions In infants with congenital heart disease,preoperative heart function grade 1,NNIS grade 0 ~ 1 ,ASA grade 1,no lung infection and no or mild pulmonary hypertension benefit early withdrawing of ventilator and preoperative cardiac function grade 1 is an inde-pendent factor for early weaning.
ABSTRACT
Objective To investigate the risk factors of extubation failure following surgical repair of congenital heart defects (CHD) in infants.Methods Infantile patients who underwent surgical repair of CHD under cardiopulmonary bypass (CPB) in the First Affiliated Hospital of Sun Yat-Sen University from January 2015 to October 2016 were included.According to results of extubation,the patients were divided into the extubation failure group and extubation success group.Clinical and laboratory data were collected and analyzed,including age,gender,body mass,the types of congenital heart disease,extracorporeal circulation time and the use of vasoactive drug,et al.Results Sixty cases were enrolled in this study.Among them 12 cases (7 males,5 females with the boy to girl ratio of 1.4 ∶ 1.0,and average age was 0.56 years old) were in the extubation failure group,in which 3 cases (25.0％)aged ＜3 months,5 cases(41.6％) aged 3-6 months.Eight cases(66.7％) weighed ≤5 kg and 4 cases(33.3％)weighed ＞ 5-10 kg.Forty-eight cases (27 males,21 females;the boy to girl ratio was 1.2 ∶ 1.0 and average age was 1.15 years old) were in the extubation success group.The distribution of age and body weight were significantly lower in the extubation failure group than those in the extubation success group [0.42 (0.37) years old vs.1.00 (1.08)years old,Z=-3.22,P＜0.01;5.00 (1.25) kgvs.8.40 (3.95) kg,Z=-3.57,P＜0.01].The durations of CPB and mechanical ventilation until the initial extubation were significantly longer in the extubation failure group than those in the extubation group [114.0 (110.O) minutes vs.80.0 (45.0) minutes,Z =1.59,P ＜ 0.05;142.5 (229.5)hours vs.14.0 (48.9) hours,Z =2.00,P ＜ 0.05].The incidences of airway spasm and pulmonary infection had no difference between the 2 groups (x2 =4.00,5.54,all P ＞ 0.05).Multiple Logistic regression showed thatthe duration of CPB was an independent risk factor of extubation failure [odds ratio (OR) =0.967,95％ CI:0.956-0.997,P =0.024].Conclusions The risk factors of extubation failure include young age,low body weight,and prolonged CPB and mechanical ventilation.CPB time is an independent risk factor of extubation failure following cardiac surgery in infants.
ABSTRACT
Objective To investigate the risk factors of extubation failure following surgical repair of congenital heart defects (CHD) in infants.Methods Infantile patients who underwent surgical repair of CHD under cardiopulmonary bypass (CPB) in the First Affiliated Hospital of Sun Yat-Sen University from January 2015 to October 2016 were included.According to results of extubation,the patients were divided into the extubation failure group and extubation success group.Clinical and laboratory data were collected and analyzed,including age,gender,body mass,the types of congenital heart disease,extracorporeal circulation time and the use of vasoactive drug,et al.Results Sixty cases were enrolled in this study.Among them 12 cases (7 males,5 females with the boy to girl ratio of 1.4 ∶ 1.0,and average age was 0.56 years old) were in the extubation failure group,in which 3 cases (25.0％)aged ＜3 months,5 cases(41.6％) aged 3-6 months.Eight cases(66.7％) weighed ≤5 kg and 4 cases(33.3％)weighed ＞ 5-10 kg.Forty-eight cases (27 males,21 females;the boy to girl ratio was 1.2 ∶ 1.0 and average age was 1.15 years old) were in the extubation success group.The distribution of age and body weight were significantly lower in the extubation failure group than those in the extubation success group [0.42 (0.37) years old vs.1.00 (1.08)years old,Z=-3.22,P＜0.01;5.00 (1.25) kgvs.8.40 (3.95) kg,Z=-3.57,P＜0.01].The durations of CPB and mechanical ventilation until the initial extubation were significantly longer in the extubation failure group than those in the extubation group [114.0 (110.O) minutes vs.80.0 (45.0) minutes,Z =1.59,P ＜ 0.05;142.5 (229.5)hours vs.14.0 (48.9) hours,Z =2.00,P ＜ 0.05].The incidences of airway spasm and pulmonary infection had no difference between the 2 groups (x2 =4.00,5.54,all P ＞ 0.05).Multiple Logistic regression showed thatthe duration of CPB was an independent risk factor of extubation failure [odds ratio (OR) =0.967,95％ CI:0.956-0.997,P =0.024].Conclusions The risk factors of extubation failure include young age,low body weight,and prolonged CPB and mechanical ventilation.CPB time is an independent risk factor of extubation failure following cardiac surgery in infants.
ABSTRACT
Objective To explore the development and interaction of left and right ventricular function in healthy children using tissue Doppler imaging.Methods Healthy children aged 0-15 years and adolescents were recruited,then children were divided into 6 groups:0-1 year,＞ 1-3 years,＞ 3-6 years,＞ 6-9 years,＞ 9-12 years,＞ 12-15 years.Healthy adolescents aged ＞ 15-25 years were also recruited.Every subject underwent echocardiography including cardiac dimension measurements,atrio-ventricular valvular velocity and early-diastolic flow velocity(E)/late-diastolic flow evlocity(A) ratio measured by pulsed color Doppler,atrio-ventricular annular myocardial velocity (including systolic velocity (s),early diastolic velocity (e) and late diastolic velocity (a)),time intervals (including isovolumic contraction time,ejection time and isovolumic relaxation time),isovolumic acceleration (ⅣA) and Tei index measured by tissue Doppler imaging.Results were compared among different groups,the correlations with age and other factors were explored.Furthermore,comparison was done between left and right ventricular functional parameters.Results Left ventricular Tei index and isovolumic contraction time were significantly lower during puberty.From infancy to pre-school stage,left ventricular E/A (flow velocity) and e/a(tissue velocity) increased accordingly,then presented with no significant changes among the following age groups(P ＞ 0.05).There were no significant differences in right ventricular Tei index,ⅣA,E/A (flow velocity) and e/a (tissue velocity) among the 6 groups (P ＞ 0.05).Left ventricular systolic myocardial velocity (s) and ⅣA were significantly lower than right ventricle (all P ＜ 0.001).However,left ventricular E/e(flow velocity) and e/a(tissue velocity) were significantly greater than right ventricle (all P ＜0.001).Conclusions In healthy children,left ventricular systolic function enhances during puberty,diastolic function increases from infancy to pre-school stage,then keeps stable till adolescents.Right ventricular systolic and diastolic function present with no significant changes during growth.Left ventricular diastolic function is greater than right one,however,right ventricular longitudinal systolic function is greater than left one.