2017 年第 10 期 第 12 卷

全肺静脉异位引流患者术后早期体温变化对心功能的影响

Effect of early postoperative temperature changes on cardiac function in patients with total anomalous pulmonary venous drainage

作者：靳燕芬秦彦荣王艳蓉胡晓鸿李淑兰

英文作者：Jin Yanfen Qin Yanrong Wang Yanrong Hu Xiaohong Li Shulan

单位：100029首都医科大学附属北京安贞医院护理部(靳燕芬、秦彦荣、胡晓鸿)；100069北京，首都医科大学护理学院（李淑兰）；100020北京，首都儿科研究所心脏重症监护病房（王艳蓉）

英文单位：Department of Nursing Beijing Anzhen Hospital Capital Medical University Beijing 100029 China（Jin YF Qin YR Hu XH）; School of Nursing Capital Medical University Beijing 100069 China （Li SL）; Cardiac Intensive Care Unit Capital Institute of Pediatrics Beijing 100020 China （Wang YR）

关键词：全肺静脉异位引流；体温；心功能

英文关键词：Totalanomalouspulmonaryvenousdrainage;Bodytemperature;Cardiacfunction

• 摘要：

• 目的 探讨全肺静脉异位引流（TAPVC）患者术后早期体温变化对心功能的影响。方法 回顾性分析2011年6月至2014年10月于首都医科大学附属北京安贞医院行TAPVC手术矫治的153例患者的临床资料。分析患者术后24 h内体温变化情况，比较不同体温患者心功能情况包括各时点中心静脉压水平、左心房压力及其他心功能情况。结果 患者术后6、12、18、24 h体温均高于术后即刻体温，术后6 h达到高峰，之后呈现下降趋势。术后24 h内，有62例（40.5%）出现发热（术后直肠温度≥38.0 ℃），作为发热组；有91例（59.5%）术后直肠温度＜38.0 ℃，作为非发热组。发热组术后即刻、6、12、18、24 h中心静脉压水平与非发热组比较,差异均无统计学意义（均P＞0.05）。2组内术后即刻、6、12、18、24 h中心静脉压水平比较，差异均无统计学意义（均P＞0.05）。发热组术后即刻、6、12、18、24 h左心房压力高于非发热组［(13±4)mmHg(1 mmHg=0.133 kPa)比(10±4)mmHg、(12±4)mmHg比(10±4)mmHg、(11±4)mmHg比(10±3)mmHg、(12±5)mmHg比(10±4)mmHg、(12±4)mmHg比(10±4)mmHg］，差异均有统计学意义（均P＜0.05）；2组内术后即刻、6、12、18、24 h左心房压力比较，差异均无统计学意义（均P＞0.05）。发热组术前和术后左心室内径高于非发热组［18.5（15.2，22.0）mm比16.0（13.3，19.0）mm、21.0（18.8，26.0）mm比19.0（18.0，23.5）mm］，差异均有统计学意义（均P＜0.05）。发热组房间隔缺损直径与非发热组比较，差异无统计学意义（P＞0.05）。结论 TAPVC患者术后24 h体温呈升高趋势，高体温不影响患者的中心静脉压水平，但会提高左心房压力，易使左心室内径增大，对左心功能产生不良影响。

• Objective To investigate the effect of early postoperative temperature changes on cardiac function in patients with total anomalous pulmonary venous drainage（TAPVC）. Methods Clinical data of 153 patients who had TAPVC in Beijing Anzhen Hospital, Capital Medical University from June 2011 to October 2014 were analyzed retrospectively. Changes of temperature in postoperative 24 h were recorded. Central venous pressure, left atrial pressure and other cardiac function indexes were analyzed between patients with different temperature changes. Results The postoperative temperature reached a peak at postoperative 6 h and showed a downtrend at 12, 18, 24 h, but it was still higher than the immediate postoperative temperature. Sixty-two patients（40.5%） who had fever（rectal temperature≥38.0 ℃） in postoperative 24 h were collected as fever group; other 91 patients（59.5%, rectal temperature＜38.0 ℃） were as non-fever group. Central venous pressures at 0, 6, 12, 18, 24 h after operation showed no significant differences between fever group and non-fever group（P＞0.05）. Left atrial pressures at 0, 6, 12, 18, 24 h after operation in fever group were significantly higher than those in non-fever group［（13±4）mmHg vs （10±4）mmHg, （12±4）mmHg vs （10±4）mmHg, （11±4）mmHg vs （10±3）mmHg, （12±5）mmHg vs （10±4）mmHg, （12±4）mmHg vs （10±4）mmHg］（P＜0.05）; there were no significant differences of left atrial pressure among different time points（P＞0.05）. Preoperative and postoperative left ventricular diameters in fever group were significantly higher than those in non-fever group［18.5（15.2，22.0）mm vs 16.0（13.3，19.0）mm, 21.0（18.8，26.0）mm vs 19.0（18.0，23.5）mm］（P＜0.05）. The diameter of atrial septal defect had no significant difference between groups（P＞0.05）. Conclusion High body temperature in post-TAPVC 24 h dose not affect central venous pressure but it increases left atrial pressure and left ventricular diameter, which has adverse effects on left ventricular function.