Background Early major adverse event has a high mortality rate after cardiac surgery. In this study, our goal was to investigate the risk factors associated with early MAE in infants after cardiac surgery, develop a prediction model, and assess its accuracy in predicting outcomes. Methods A model was constructed incorporating 766 patients at our Hospital from January 2020 to December 2021. Participants were randomly divided into modelling and validation group using a 7:3 ratio. We utilized the least absolute shrinkage and selection operator regression analysis to screen the variables, and then conducted a multiple logistic regression analysis to create a prediction nomogram. Results The risk factors of MAE were weight, aortic clamp time, postoperative 8th hour lactate, off-CPB blood glucose and postoperative 4 hours urine output. The Hosmer−Lemeshowtest demonstrated that the model was a good fit (χ²=6.105, p=0.636). The clinical decision curve analysis showed significantly better net benefit in the predictive model, as well as that in the validation cohort. Conclusion The prediction model based on perioperative factors was developed to screen the occurrence of early MAE in infants after cardiac surgery. It provided physicians with an effective tool for the early prediction, and took timely preventive measures.

Objective:To analyze the clinical outcomes and to explore the feasibility and influencing factors of early extubation (EE) in neonates and young infants after congenital heart disease (CHD) repair.Methods:We conducted a retrospective analysis of neonate and young infants with CHD who underwent cardiac surgery at Fuwai Hospital between January 1, 2017, and December 31, 2019.A total of 391 patients were included.According to the mechanical ventilator time (MVT) after admitted to the PICU, patients were divided into two groups: EE group (MVT <24 h) and nonEE group (MVT>24 h). Univariate and multivariate analysis was used to identify the risk factors for EE.Complications and clinical outcomes were compared between the EE group and the nonEE group.Results:In univariate analysis, the significantly differences were found in age, weight, ACC time, CPB time, and RACHS-1.Multivariate logistic regression analysis indicated that low weight ( OR=0.648, 95% CI: 0.471~0.893)and BT procedure( OR=0.109, 95% CI: 0.013~0.934) were independent risk factors for EE.Overall, EE was achieved in 65% of all cases.Operative mortality was 2.3%, and no patient died in the EE group.The total number of neonates was 136 accounting for 34.9% of all patients, and the EE rate in neonates was 58.8%.The MVT and ICU length of stay in the EE group were shorter than that in the nonEE group ( P<0.001). The re-intubation rate(3.15% vs.12.4%) and postoperative infection rate(1.18% vs.14.6%)in the EE group were lower compared with that in the nonEE group ( P<0.05). Conclusion:Most neonates and infants with complex CHD can achieve EE after surgery.EE was associated with a lower postoperative infection rate and shorter length of stay of ICU and MVT.Low body weight and BT procedure are independent risk factors for EE in neonates and young infants following complex CHD repair.

目的:总结应用可吸收聚左旋乳酸(PLLA)微骨板外固定术治疗先天性心脏病(先心病)合并支气管软化患儿的经验.方法:回顾性分析2017年12月至2019年1月,在我中心接受可吸收PLLA微骨板外固定术治疗先心病合并支气管软化的患儿8例,其中男性2例,女性6例.平均年龄(8.4±4.1)个月,平均体重(6.5±1.2)kg.观察术后机械通气时间、重症监护病房(ICU)时间、呼吸系统并发症等评估治疗效果.并于术后1、3、6、12个月复查超声心动图和胸部CT.结果:8例患儿中7例成功接受同期心脏畸形矫治和支气管可吸收PLLA微骨板外固定术,1例成功接受单纯支气管可吸收PLLA微骨板外固定手术.全组无围术期死亡,术后呼吸机辅助时间(24.4±23.7)小时,ICU时间(3.8±3.8)天.平均随访时间(6.5±6.2)个月,超声心动图显示所有患者心脏畸形矫治满意,CT显示支气管通畅.结论:采用可吸收PLLA微骨板外固定术治疗先心病合并支气管软化简便易行,治疗效果明显,可显著缩短机械通气时间及ICU时间,降低费用.近期效果满意.

Objective: To explore the clinical value of extravascular lung water monitoring for rapid recovery in pediatric patients after complete repair of tetralogy of Fallot (TOF). Methods: A total of 43 pediatric patients received complete repair of TOF were studied. The pulse contour cardiac index (PCCI), global end diastolic volume index (GEDI), stroke volume variation (SVV), systemic vascular resistance index (SVRI), global ejection fraction (GEF), maximum of pressure increase in aorta (dPmax), extravascular lung water index (EVWI) and pulmonary vascular permeability index (PVPI) were recorded by pulse-indicated continuous cardiac output (PICCO) monitoring at immediately enter pediatric ICU (PICU) and 6h, 12h, 18h, 24h post-operation. Meanwhile, the heart rate, blood pressure, central venous pressure (CVP), left atrium pressure (LAP) and balance of liquid were monitored; mechanical ventilation time, PICU stay time, re-intubation,re-occlusion of major aortopulmonary collateral arteries (MAPCAs) and other complications were recorded. Based on post-operative mechanical ventilation time, the patients were divided into 2 groups: Rapid recovery (R) group, patients with mechanical ventilation≤24h, n=29 and Delayed recovery (D) group, patients with mechanical ventilation>24h, n=14. Results: Compared with group D, group R had the shorter mechanical ventilation time (14.2±8.0) h vs (86.3±44.5) h and PICU stay time (2.5±1.7) days vs (5.3±3.6) days, both P<0.05; decreased PVPI at immediately enter PICU and 6h, 12h, 18h, 24h post-operation as (4.9±1.3 vs 6.4±1.5),(5.1±1.8 vs 6.5±1.3),(4.8±2.0 vs 6.5±1.6),(4.4±1.1vs 6.9±1.8), (4.4±2.5 vs 6.5±2.2) respectively, all P<0.05; Lower ELWI at 12h and 18h post-operation as(20.9±6.1) ml/kg vs (26.8±5.7) ml/kg and(19.1±5.5) ml/kg vs (26.7±5.5)ml/kg, both P<0.05. Group R had no patient received re-occlusion of MAPCAs after operation, while Group D had 3. No death, no catheter-related complication occurred in either group. Conclusion: MAPCAs may increase extravascular lung water, pulmonary vascular permeability and cause lung perfusion, therefore affect the early recovery of complete repair of pediatric TOF. PICCO monitoring may conduct bedside quantitative observation of lung perfusion, combining with ELWI and PVPI, clinicians may identify and manage MAPCAs as necessity for rapid recovery in relevant patients.

Objective To recognize the risk factors of unplanned re-interventions within 30 days after pediatric cardiac surgery and evaluate the outcome of re-interventions. Methods We retrospectively analyzed the clinical data of 202 children in Fuwai Hospital between January 1, 2015 and August 31, 2017. There were 115 males and 87 females at average age of 32.4 months with range of 3 days to 14 years. Results There were 202 children who underwent unplanned re-intervention during 30 days post-operation, including 54 re-adjustments of pulmonary blood flow, 34 re-corrections for residual cardiac abnormalities, 28 cardiopulmonary resuscitations, 38 for coagulation problems, 19 pericardial drainages, 11 palliative re-operations to deliver heart load and 6 diaphragmatic folds and 12 others. The mortality rate among children who underwent unplanned re-inventions after cardiac surgery was 10.9％ (22/202). It was much higher than those free from re-interventions (0.7％). Time of mechanical ventilation was 284.3 (11-2 339) h, and mean ICU stay was 17.7 (1-154) d, significantly longer than those free from re-interventions at the same period. Conclusion Unplanned reinterventions after pediatric cardiac surgery is associated with higher mortality rate and longer recovery time. Early identifying risk factors and re-intervention can reduce the complications and improve the prognosis.

目的:ECMO 作为先心病术后心肺支持的重要手段,为受损的心、肺功能的恢复赢得了时间,使一部分以往无法存活的患儿得到了生存的机会.本文旨在探讨小儿多学科团队协作并发症防控模式对降低 ECMO 期间并发症及死亡率的作用.

目的 通过分析体外膜肺氧合(ECMO)技术在小儿复杂先天性心脏病术后应用前后的临床数据及治疗情况,为进一步提高ECMO辅助病人抢救的成功率提供依据.方法 回顾分析2012年1月至2015年6月我中心31例接受ECMO辅助患儿的临床资料.患儿应用ECMO的指征为:术中难以脱离体外循环机和术后出现严重低心排或心跳骤停,经常规治疗仍无效者.结果 患儿年龄53天～8.0岁,体重4.3 ～ 28.3kg.ECMO辅助时间70～355(146.48±66.82)小时,31例患儿中脱离ECMO辅助22例(71.0％),最终存活15例(48.4％),死亡16例(51.6％).死亡组患儿应用ECMO辅助前的血管活性药物评分平均为64.69,明显高于存活组的48.03.死亡原因有心功能持续不恢复9例、脑死亡3例、感染2例、肾功能衰竭2例.结论 ECMO适应症的选择和期间的精细管理、降低相关并发症是影响ECMO辅助疗效的影响因素.

Objective To investigate the methods of early identification and early intervention for newborn with life-threatening congenital heart disease.Methods Between January 2010 and December 2010,223 neonates with serious congenital cardiac malformations were hospitalized in PICU of Fuwai Hospi-tal.Results The most type of cardiac lesions was complete transposition of the great arteries,accounting for 59%(131 cases),and the second was total anomalous pulmonary venous connection,17%(39 cases).For the primary clinical symptoms,the most common were any cyanosis,dyspnea and cardiac murmur,accounting for 91 %(204 cases),56%(125 cases)and 53%(1 18 cases),respectively.Fifty-nine cases developed into critical conditions such as severe hypoxia,metabolic acidosis and heart failure and were sent to PICU for emergency rescue.Early intervention included maintaining ductus arteriosus open,correcting internal environ-ment disturbances,treatment of heart failure,and surgical treatment as soon as possible.Four cases died before operation and 10 cases were abandoned to continue care,which all died within 12 days after discharge.In 209 cases who received operation,9 cases died.The total operation mortality was 4.3%.Within 3 to 63 month following-up,the late death was in 2 cases,2 cases received two-stage corrective operation,and three for reop-eration.The others all were in normal cardiac function and growth.Conclusion Most of neonatal life-threat-ening congenital cardiac malformations were ductus dependent such as transposition of the great arteries and total anomalous pulmonary venous connection,which the baby needs immediate diagnosis and management for survival.Early recognition,appropriate preoperative management and operation as soon as possible are the key to rescue.

目的：受病种及术式复杂程度的影响，小儿先心术后ECMO辅助的情况更为复杂。本文通过分析不同ECMO适应证、上机指征、管理策略与辅助时间与预后的关系，为进一步改善临床治疗效果提高依据。

目的：随着小儿心脏外科整体治疗水平的提高，与先心病外科治疗相关的死亡率和并发症都获得了极大的改善。在这种低死亡率的背景下，如何进一步促进低龄复杂先心病的快速康复，降低ICU滞留时间和总住院时间，成为小儿外科中心新的工作目标。本文探讨低龄复杂先心病外科术后早期拔管的可行性及相关风险因素。

Introduction: Infants and children after cardiac surgery may develop hyper- or hypoglycemia, associating with higher nosocomial infection or neurological morbidities. Hypothesis: The hypothesis of this perspective randomized control study is moderate glucose control may improve clinical outcomes. Methods: We randomly assigned children(≤3 years of age) who were admitted to the pediatric cardiac intensive care unit (PICU) after cardiopulmonary bypass surgery into either moderate glucose control group (target blood glucose: 110-143mg per deciliter) or conventional glucose control group (target level below 200mg per deciliter). The primary outcome was the rate of nosocomial infection in PICU. Second outcomes include hospital mortality, duration of mechanical ventilation and PICU stay, and a composite morbidity variable included events of requiring extracorporeal membrane oxygenation, delayed sternal closure, dialysis-dependent renal failure and hypoglycemia. Results: A total of 593 patients underwent randomization: 293 to moderate glucose control group and 300 to conventional glucose control group. The baseline data were balanced between these two groups. Mean 72 hours time-weighted blood glucose average was lower in the moderate control group than in the conventional group (129.9±22.1 mg per deciliter vs. 138.8±28.6 mg per deciliter, p<0.001). Although no statistically significance reached, there is a trend that nosocomial infection occurred less in moderate glucose group (17 (5.80%) vs. 29 (9.67%), P=0.054). Duration of mechanical ventilation was shorter in the moderate control group (18 (range, 4-300) hours vs 22 (range 3-771) hours, p=0.046). Hypoglycaemia (blood glucose ≤65mg per deciliter) which occurred in 7(2.39%) patients in the moderate group versus 8 (2.67%) in the conventional group, was statistically similar between groups. Other secondary outcomes did not differ significantly between groups. Conclusions: With moderate glucose control, although the major clinical outcomes did not change, this randomized control study showed shorter ventilation time after pediatric cardiac surgery, substantially benefit for patients with complex congenital cardiac anomalies.

目的:观察并评价吸入一氧化氮联合西地那非治疗全腔静脉-肺动脉连接术(TCPC)后早期肺动脉高压(PAH)的安全性.方法:分析2010年1月至2014年12月,阜外心血管病医院采取吸入一氧化氮(iNO)联合西地那非治疗的56例TCPC术后,早期合并PAH患儿的临床资料,PAH的诊断标准为:①术前平均肺动脉压力(mPAP)≥13mmHg(1mmHg=0.133kPa);②术后早期循环不稳、中心静脉压(CVP)≥15mmHg或跨肺压差(TPG,即中心静脉压与左心房压的压力差值)≥10mmHg.男性37例,女性19例,平均年龄(63.3±23.9)rn,平均体质量(17.5±4.1)kg,术前平均肺动脉压力(mPAP)(14.7±1.5) mmHg,平均左心室射血分数(63.1±6.3)％,术前经皮氧饱和度(79.2±7.3)％,术前血红蛋白含量(180.1±24.6)g/L.分别记录治疗开始前、治疗开始后24小时的各项血流动力学和呼吸功能指标,定期监测二氧化氮(NO2)、高铁血红蛋白(MetHb)含量、血小板及肝肾功能.结果:56例TCPC术后早期合并PAH患儿经iNO联合西地那非治疗后,循环逐步稳定,容量需求、胶体入量及血管活性药评分减少,CVP从(15.2±3.2)mmHg降至(11.2±2.2)mmHg,TPG从(10.8±2.5) mmHg降至(5.8±1.8)mmHg,氧合指数从(203±77) mmHg升至(278±90) mmHg.iNO联合西地那非治疗期间,NO2浓度均＜1 ppm,平均0.3(0.1,0.5)ppm;MetHb均在3％以下,平均(1.5±0.5)％,均属于安全范围;无患儿出现血小板减少、肝肾功能异常及明显不良反应的表现.结论:吸入一氧化氮联合西地那非在TCPC术后早期PAH患儿中应用是安全可行的.

目的 总结全腔静脉肺动脉连接术(total cavopulmonary connection,TCPC)经房间隔开窗治疗复杂先天性心脏病的早期疗效.方法 回顾性分析2010年1月至2013年12月阜外心血管病医院142例行TCPC患儿的临床资料.根据其是否行房间隔开窗分为2组:开窗组,71例,男44例、女27例,年龄(65.7±24.5)个月;未开窗组,71例,男42例、女29例,年龄(60.7±20.8)个月.比较两组患儿围术期资料.结果 142例患儿术后早期死亡4例(2.82％).术前合并有中大量房室瓣反流(AVVI)并同期矫治的患儿行房间隔开窗的比例大大增加.两组患儿的机械通气时间、住ICU时间、早期死亡率及并发症发生率差异均无统计学意义(P＞0.05),但开窗组较未开窗组患儿术后胸腔积液持续时间更短(9.1 dvs.13.1 d)、24h容量需求亦更低[4.19 ml/(kg·h)vs.5.48 ml/(kg·h)].对于术前平均肺动脉压(mPAP)≥12 mm Hg者,开窗组患儿术后早期中心静脉压(CvP)较未开窗组更低(P=0.046),维持相同的血压(收缩压80～90 mm Hg)开窗组所需的血管活性药评分(P=0.019)、24 h容量需求(P=0.041)均更低,胸腔积液持续时间更短(9.8 d vs.17.8 d,P=0.000).对113例复诊患儿进行随访,平均随访时间(1.1±1.2)年,发现开窗患儿动脉血氧饱和度(SpO2)为92.1％±3.5％,开窗患儿窗口自然闭合率为8.5％,无患儿发生严重紫绀(SPO2＜85％)、肢体栓塞及脑卒中.结论 对TCPC患儿无需常规开窗,开窗与未开窗患儿均可获得满意的早期临床疗效,但对于合并有中大量AVVI并同期矫治、尤其是mPAP≥12 mm Hg的高危患儿应考虑行房间隔开窗,开窗有助于术后早期循环的稳定,缩短胸腔积液持续时间.

目的：总结左冠状动脉起源异常患儿根治术后早期处理的经验，提高治疗效果。<br>　　方法：2010-01至2015-01，阜外医院小儿外科中心共手术根治左冠状动脉起源异常46例，病人的一般资料，男性28例，女性18例；年龄：中位数17 m，四分位间距（7 m，55.8 m）；体重（13.6±10.8）kg。术前例经超声和增强CT检查确诊，异常起源的左冠状动脉均发自肺动脉。以左射血分数50%为标准，术前心功能正常28例，超声、CT均提示冠脉之间有侧支形成；心衰18例，超声及CT未发现明显侧支形成，或侧支形成不充分。8例存在二尖瓣中大量以上反流，以前瓣脱垂为主。

目的：探索先天性心脏病合并气管狭窄的诊断和治疗。<br>　　方法：2012-01至2014-12间先心病合并气管狭窄的患儿22例，患儿年龄24天~53个月；体重4~14 kg。术后反复脱机困难或肺不张，行纤维支气管镜，部分患儿行CT检查发现。上段6例，中下段16例，支气管桥3例，主气管环形狭窄4例，支气管开口狭窄8例，支气管环形狭窄1例，左支气管受压10例，气管起源异常3例，支气管口堵塞2例。

目的：探索TOF根治术后早期心功能指标、压力指标、容量指标以及肺水指标的变化，评估PICCO技术在指导TOF根治术后早期治疗中的临床价值。<br>　　方法：小儿TOF根治术后病例38例，于返回PICU后置入PICCO监测导管，经中心静脉导管注射冰盐水，机器自动测量并计算心指数（CI）、全心舒张末期容量指数（GEDI）、全心射血分数（GEF）、血管外肺水指数（EVWI）及肺血管通透性指数（PVPI），并连续监测心输出量指数（PCCI）、左心室收缩力指数（dPmx）、每搏量变化率（SVV）及外周血管阻力指数（SVRI）等参数。此后，每6小时注射冰盐水一次，记录上述各参数。根据临床恢复结果将病例分为快速康复组和延迟恢复组，应用SPSS19统计软件对两组资料进行统计学分析。

Objective To explore the changes in pulmonary surfactant (PS) and to analyze the clinical data of the complex congenital heart disease(CHD) infants who got acute respiratory distress syndrome (ARDS) after surgery and those of the simple CHD infants who recovered smoothly after surgery.Methods Fifteen infants less than 3 months with congenital cardiac defects undergoing cardiovascular surgery and developed ARDS after operation were chosen as ARDS group,other 15 infants without ARDS were chosen as a control group.The data of mean mechanical ventilation time,the intensive care unit treatment time,mortality and the incidence of postoperative complications were collected.And saturated phosphatidylcholine (SatPC),total phospholipids (TPL) and total protein (TP) in sequential airway aspirates and surfactant protein-A (SP-A) in the blood after operation were determined.Results The mean mechanical ventilation time of ARDS group [(6.69 ± 2.35) d] was longer than that of the control group [(0.90 ±0.84) d] (t =8.986,P ＜ 0.01),and the mean ICU treatment time of ARDS group [(7.20 ± 3.39) d] was longer than that of the control group [(1.56 ± 0.77) d] (t =6.283,P ＜ 0.01).ARDS group had a higher rate of mortality (6.67％) and the incidence of postoperative complications (46.67％) than that of the control group (0) (F =10.562 5,2.227 3,all P ＜ 0.05).Plasma SP-A level in ARDS group [(148.18 ± 19.18) mg/L] was higher than that in the control group [(93.06 ± 12.39) mg/L] (t =9.349,P ＜ 0.01).The SatPC/TPL decreased in ARDS group [(0.602 9 ± 0.045 1) ％] compared with that in the control group [(0.819 9 ± 0.074 1) ％] (t =-9.689,P ＜0.01).The SatPC/TP was decreased in ARDS group[(0.085 6-± 0.069 5) mg/g] compared with that in the control group [(0.485 5-± 0.039 5) mg/g] (t =-19.374,P ＜ 0.01).Conclusions ARDS after the surgery of CHD may significantly reduces PS activity in the lungs and its loss into blood.Their recovery process may be longer than that of the simple simple CHD infants with unstable conditions.

Objective To determine whether or not the changes of surfactant occur in neonates undergoing condiopulmonary bypass (CPM) surgery.Methods A total of 25 infants with congenital heart disease aged under 30 days were recruited.There were 19 males and 6 females with an average age of 20.9 (7-30) days and an average weight of 3.8 (2.6-4.6) kg.The grades of Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) were Ⅱ-Ⅳ.Blood samples were collected from 25 patients and serial plasma concentrations of surfactant protein A (SP-A) measured with enzyme-linked immunosorbent assay.They were divided into delayed (n =8) and control (n =17) groups according to whether or not the duration of intensive care unit (ICU) was longer than 7 days.Results At 2-120 h post-operation,the plasma concentration of SP-A increased time-dependently,including two peaks at 12 and 72 h.The average age and body weight of delayed group were less than those of control group (13.0 ± 4.1 vs 25.6 ± 4.7 days; 2.4 ± 0.6 vs 4.9 ± 2.2 kg).And operative blockage time and CPB were longer in delayed group than control group (94 ± 22 vs 62 ± 16 min; 181 ± 18 vs 120 ± 14 min).The mean mechanical ventilation time was longer in delayed group than control group (8.2 ± 7.3 vs 1.5 ± 0.9 days).There was a higher incidence of postoperative complications in delayed group than control group (50.0％ vs 5.9％,P＜0.05).The serum level of SP-A after 12h was significantly higher in delayed group than that in control group.And a strong correlation existed between the level of SP-A after 12h and ICU duration.Conclusions The serum concentration of SP-A increases after CPB in neonates.The higher concentration of SP-A,the more a patient is prone to ICU retention.Thus SP-A is a new type of biomarker for alveolar capillary injury.

目的：探索复杂先天性心脏病不同姑息手术后抗凝治疗的特点及方法。

目的：通过对先心病外科快速康复技术下患儿围手术期临床资料的分析，探讨积极早拔管策略在低龄复杂先心病术后实施的可行性。并分析可能影响早期拔管（呼吸机辅助时间≤24 h）的相关风险因素。