Diagnosis and treatment of early postoperative tachycardia in patients with congenital heart disease / 中国综合临床

ABSTRACT

Objective:To analyze and clarify the causes, types, risk factors and treatment principles of early postoperative tachycardia in children with congenital heart disease.Methods:A retrospective analysis of the clinical data of 2 126 children with primary radical congenital heart surgical procedure in Shanghai Children′s Hospital from January 2014 to December 2020, including 1 322 cases of ventricular septal defect or ventricular septal defect combined with atrial septal defect, 421 cases of atrial septal defect, 194 cases of tetralogy of Fallot, D-transposition of the great artery or double outlets of right ventricle combined with pulmonary stenosis, and 189 cases of other complex congenital heart disease. The surgical method is a median sternal skin incision or a small right axillary skin incision, and cardiopulmonary bypass is established routinely. The age, body mass, disease type, cardiopulmonary bypass and aortic occlusion time, vasoactive drug use, ECG monitoring and other indexes were observed and monitored.Results:There are 425 cases of early postoperative tachycardia in 2 126 children with congenital heart disease, with an incidence of 20.0%. The incidences of sinus tachycardia, borderline ectopic tachycardia, atrial tachycardia and ventricular tachycardia were 14.8%(314/2 126), 4.5%(96/2 126), 0.8%(17/2 126) and 0.5%(10/2 126), respectively. Logistic regression analysis revealed that the low age ( OR=1.98, 95% CI: 1.25-2.65, P<0.01), low weight ( OR=2.35, 95% CI:1.86-2.75, P<0.01), large ventricular septal defect ( OR=1.56, 95% CI:1.09-2.06, P=0.02), complex congenital heart disease ( OR=2.03, 95% CI: 1.57-2.52, P<0.01), long duration of cardiopulmonary bypass ( OR=1.77, 95% CI: 1.23-2.28, P<0.01), long aortic cross-clamp time ( OR=1.89, 95% CI:1.20-2.55, P<0.01), acidosis ( OR=1.63, 95% CI:1.11-2.14, P<0.01), and the combination usage of vasoactive drugs ( OR=1.86, 95% CI:1.23-2.48, P<0.01) were significantly associated with the occurrence of early postoperative tachycardias. Conclusion:This study has important clinical guiding value for predicting early postoperative tachycardia in children with congenital heart disease, clarifying its causes and types, and timely handling, so as to improve the postoperative survival rate of children.