Early outcome and risk factors analysis of Blalock-Taussig shunt / 中国小儿急救医学

ABSTRACT

Objective To investigate the early curative effect of Blalock-Taussig(B-T) shunt and summarize the key point in its post-operative intensive care,analyze the related risk factor of its mortality.Methods We collected 71 patients who received B-T shunt in Shanghai Children's Medical Center from June 2015 to June 2017. All of 71 cases were divided into neonates group (25 cases) and non-neonate group (46 cases). All patients were operated through median sternotomy,19 were emergency cases,in which 15 cases were neonates. Eight cases used cardio-pulmonary bypass in our study,in which 4 cases were neonates. Twenty-nine cases received ductus ligation in total 34 patients with patent ductus arterious. Percutaneous heparin was immediately administered after operation as an anticoagulation therapy. Relative large dosage inotropic agents was used after sufficient volume infusion in order to guarantee diastolic pressure higher than 35 mmHg(in neo-nates >30 mmHg,1 mmHg =0. 133 kPa). Ventilator parameter was adjusted to obtain appropriate flow distribu-tion between pulmonary and systemic circulation. In order to avoid excessive pulmonary flow,the target PO2 was set between 40 ～ 45 mmHg. Results Oxygen saturation elevated by 15％ after operation in all 71 cases. Average mechanical ventilation time was 92 hours,mean inotropic agents score was 17. There were 6 dead cases,mortality was 8. 5％ . In neonates,4 cases dead,mortality was 16. 0％ . There was no significant difference in ventilation time,ICU retention day and mortality between neonates group and non-neonates group. The logis-tic regression analysis showed that the body weight and ratio between the shunt conduit diameter and body weight (mm/ kg) were the risk factors for early post-operative mortality[body weight:2500 ～ 3500 g:OR =6. 729,95％ CI =1. 373 ～17. 131;≤2500 g:OR = 7. 832,95％ CI = 2. 563 ～ 28. 325. the ratio between the shunt conduit diameter and body weight (mm/ kg):1. 10 ～1. 15:OR = 4. 204,95％ CI = 1. 195 ～ 23. 926;≥1. 15:OR= 3. 981,95％ CI =1. 195 ～12. 926]. Conclusion B-T shunt is still a high risk operation although it is a palli-ative method. Low body weight and bigger diameter conduit are the significant factors related to its mortality. Strict control of the systemic and pulmonary flow ratio is the key point in the post-operation intensive care.