Risk factors for delayed postoperative recovery in infants with non-restrictive ventricular septal defect

doi:10.3877/cma.j.issn.1674-0785.2025.03.003

Abstract

Abstract:

Objective

To identify the risk factors for delayed recovery after surgery in infants with non-restrictive ventricular septal defects （VSD），in order to provide evidence for early intervention and optimization of treatment strategies in clinical practice.

Methods

This study included 86 infants with nonrestrictive VSD who underwent surgery at the Department of Cardiovascular Surgery of Capital Institute of Pediatrics between October 2016 and January 2025.The infants were divided into two groups based on whether their postoperative ICU stay exceeded the median duration （4 days）： normal recovery group（ICU stay≤4 days，n=49） and delayed recovery group （ICU stay＞4 days，n=37）.Univariate analysis was performed on the general data as well as preoperative，intraoperative，and postoperative clinical indicators of both groups，and variables with statistical significance were included in a binary logistic regression analysis to identify the risk factors for delayed recovery after surgery.

Results

Significant differences between the two groups were found in terms of weight，admission heart rate，respiratory status，N-terminal pro B-type natriuretic peptide，heart function classification，preoperative pulmonary hypertension，and postoperative intubation time （P＜0.05）.Binary logistic regression analysis revealed that the regression coefficients for admission respiratory status，preoperative pulmonary hypertension，and postoperative intubation time were 2.923，0.053，and 0.071，respectively，all showing statistical significance （P＜0.05），and the odds ratios were 6.84，1.055，and 1.073，respectively.

Conclusion

Preoperative pulmonary hypertension，admission respiratory status，and postoperative intubation time are independent risk factors for delayed recovery in infants with non-restrictive VSD.Early intervention and optimization of treatment are crucial in clinical practice to reduce the occurrence of delayed recovery and improve treatment outcomes.

Key words: Non-restrictive ventricular septal defect, Pulmonary hypertension, Postoperative delayed recovery, Risk factors

Shuangxing Wang, Yongjie Wu, Bing Meng, Hongtao Zhang, Dan Wei, Hui Zhang, Mei Diao. Risk factors for delayed postoperative recovery in infants with non-restrictive ventricular septal defect[J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(03): 188-193.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2025.03.003

https://zhlcyszz.cma-cmc.com.cn/EN/Y2025/V19/I03/188

Figures/Tables 3

项目	正常恢复组（n=49）	延迟恢复组（n=37）	χ ²/t/Z值	P值
男性［例（%）］	24（48.98）	20（54.05）	0.217	0.641
月龄［月，M ( Q₁,　 Q₃ )］	2.5（1.6，3.5）	1.9（1.6，2.8）	-1.781	0.075
体重（kg， $\overset{ˉ}{x}$ ± s ）	4.78±0.99	4.35±0.84	2.147	0.035^*
心功能分级［例（%）］			4.615	0.032^*
＜Ⅲ级	30（61.22）	14（37.84）
≥Ⅲ级	19（38.78）	23（62.16）
肺动脉高压［例（%）］			9.641	0.002^*
无	22（44.9）	5（13.51）
有	27（55.1）	32（86.49）
呼吸道感染［例（%）］			2.565	0.109
无	20（40.82）	9（24.32）
有	29（59.18）	28（75.68）
NT-proBNP（pg/ml）	2543（1052，5156）	3908（1895，6992.5）	-1.984	0.047^*
心率（次/ 分， $\overset{ˉ}{x}$ ± s ）	144.18±16.98	154.05±15.72	-2.754	0.007^*
呼吸（次/ 分）	35.000（30.0，48.0）	50.000（34.5，59.0）	-3.052	0.002^*

项目	正常恢复组（n=49）	延迟恢复组（n=37）	χ ²/t/Z值	P值
男性［例（%）］	24（48.98）	20（54.05）	0.217	0.641
月龄［月，M ( Q₁,　 Q₃ )］	2.5（1.6，3.5）	1.9（1.6，2.8）	-1.781	0.075
体重（kg， $\overset{ˉ}{x}$ ± s ）	4.78±0.99	4.35±0.84	2.147	0.035^*
心功能分级［例（%）］			4.615	0.032^*
＜Ⅲ级	30（61.22）	14（37.84）
≥Ⅲ级	19（38.78）	23（62.16）
肺动脉高压［例（%）］			9.641	0.002^*
无	22（44.9）	5（13.51）
有	27（55.1）	32（86.49）
呼吸道感染［例（%）］			2.565	0.109
无	20（40.82）	9（24.32）
有	29（59.18）	28（75.68）
NT-proBNP（pg/ml）	2543（1052，5156）	3908（1895，6992.5）	-1.984	0.047^*
心率（次/ 分， $\overset{ˉ}{x}$ ± s ）	144.18±16.98	154.05±15.72	-2.754	0.007^*
呼吸（次/ 分）	35.000（30.0，48.0）	50.000（34.5，59.0）	-3.052	0.002^*

项目	正常恢复组（n=49）	延迟恢复组（n=37）	χ ²/Z值	P值
手术时间［分，M ( Q₁,　 Q₃ )］	180（156.5，189）	174（150，199）	-0.184	0.854
CPB 时间［分，M ( Q₁,　 Q₃ )］	82（74.5，96）	81（63.5，111）	-0.667	0.504
ACC 时间［分，M ( Q₁,　 Q₃ )］	49（40，58）	42（33.0，59.5）	-1.261	0.207
气管插管时间［时，M ( Q₁,　 Q₃ )］	24（20，46）	69（44.5，97）	-5.321	0.000*
VIS_{24 max}	14.86（12.7，19.3）	15.59（13.3，22.5）	-1.012	0.312
术后并发症［例（%）］			0.025	0.875
有	23（46.94）	18（48.65）
无	26（53.06）	19（51.35）

	回归系数	标准误	z 值	Wald χ ²值	P值	OR	OR 值95%CI
肺动脉高压	1.923	0.771	2.493	6.216	0.013	6.840	1.509 ～ 31.012
入院呼吸	0.053	0.025	2.104	4.428	0.035	1.055	1.004 ～ 1.108
气管插管时间	0.071	0.018	3.986	15.889	0.000	1.073	1.037 ～ 1.111
截距	-7.069	1.692	-4.179	17.464	0.000	0.001	0.000 ～ 0.023

References 29

1	van der Linde D，Konings E，Slager M，et al.Birth prevalence of congenital heart disease worldwide： a systematic review and metaanalysis ［J］.J Am Coll Cardiol，2011，58（21）： 2241-2247.
2	Bellsham-Revell H，Burch M.Congenital heart disease in infancy and childhood ［J］.Med，2022，50（9）： 579-586.
3	中华医学会小儿外科分会心脏学组，国家儿童医学中心心血管专科联盟.儿童先天性心脏病相关性肺高压诊断与治疗指南［J］.中华小儿外科杂志，2022，43（11）： 966-980.
4	Chinawa JM，Duru CO，Ossai EN，et al.Pulmonary hypertension in children with ventricular septal defects ［J］.West Afr J Med，2021，38（10）： 952-957.
5	黄思纳，欧斌，刘治元，等.低体质量先天性心脏病患儿外科手术治疗危险因素分析［J］.中国实用医刊，2019，46（16）： 32-34.
6	龚雪阳，杨一峰，赵天力，等.完全生物可降解室间隔缺损封堵器植入的中期随访结果［J］.中南大学学报（医学版），2024，49（5）：795-801.
7	刘桂栋，张峰，黄晓碧，等.缺损上缘距主动脉瓣≤2 mm 室间隔缺损经胸封堵治疗有效性观察［J］.中国心血管病研究，2024，22（10）： 929-933.
8	陆叶，刘徐妹，王莉，等.儿童先心病术后并发症心肌血肿：单中心经验［J］.中华胸心血管外科杂志，2024，40（11）： 657-659.
9	Jun S，John C D，Lisa JS，et al.Risk factors for longer hospital stay following the fontan operation ［J］.Pediatr Crit Care Med，2016，17（5）：411-419.
10	李坤，谌启辉，王平凡，等.低体重婴幼儿先天性室间隔缺损外科修补术后延迟恢复的风险因素分析［J］.中国胸心血管外科临床杂志，2021，28（1）： 64-69.
11	李泉林，王澎，王文隆，等.右室肺动脉外管道置换术后延迟恢复影响因素研究［J］.中国小儿急救医学，2023，（7）： 531-535.
12	Ergün S，Genç SB，Yildiz O，et al.Risk factors for major adverse events after surgical closure of ventricular septal defect in patients less than 1 year of age： A single-center retrospective ［J］.Braz J Cardiovasc Surg，2019，34（3）： 335-343.
13	Xueying Z，Wenxia Z，Hongyu L，et al.Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass： A retrospective observational study ［J］.Int J Nurs Sci，2021，8（4）： 388-393.
14	钟丽霞，金艳鸿，李硕，等.创伤患者ICU 住院时间延长的影响因素及预测价值研究［J］.创伤外科杂志，2024，26（11）： 856-862.
15	Brett RA，Kristen NS，Susan CN，et al.Contemporary outcomes of surgical ventricular septal defect closure ［J］.J Thorac Cardiovasc Surg，2013，145（3）： 641-647.
16	Bhattacharya D，Sasikumar D，Gopalakrishnan A，et al.Ventricular septal defect with pulmonary arterial hypertension in an infant： Is there something more than what meets the eye？［J］.Ann Pediatr Cardiol，2021，14（4）： 554-556.
17	Patel R，Upadhyay V，Bansal V.Should sildenafil be started 2 weeks before the operation in ventricular septal defect patients with high pulmonary vascular resistance？［J］.J Card Surg，2021，36（1）： 422-423.
18	Novick WM，Golovenko OS，Lazorhyshynets VV，et al.Sildenafil's early，late impact on ventricular septal repair： older children using the double patch ［J］.Ann Thorac Surg，2022，114（3）： 818-825.
19	Aydemir NA，Harmandar B，Karaci AR，et al.Results for surgical closure of isolated ventricular septal defects in patients under one year of age ［J］.J Card Surg，2013，28（2）： 174-179.
20	James MK，Julie MS，Ronald ED，et al.Clinical outcomes of acute respiratory failure associated with noninvasive and invasive ventilation in a pediatric ICU ［J］.Respir Care，2022，67（8）： 956-966.
21	Emeriaud G，López-Fernández YM，Iyer NP，et al.Executive summary of the second international guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome（PALICC-2）［J］.Pediatr Crit Care Med，2023，24（2）： 143-168.
22	Kimball TR，Daniels SR，Meyer RA，et al.Relation of symptoms to contractility and defect size in infants with ventricular septal defect ［J］.Am J Cardiol，1991，67（13）： 1097-1102.
23	Berger JT，Holubkov R，Reeder R，et al.Morbidity and mortality prediction in pediatric heart surgery： Physiological profiles and surgical complexity ［J］.J Thorac Cardiovasc Surg，2017，154（2）： 620-628.e626.
24	Auten RL.Neonatal and infant physiology-impact of cardiopulmonary bypass in the developing patient ［J］.Cardiol Young，1993，3（4）： 394-406.
25	Todd Tzanetos D，Bassi H，Furlong-Dillard J，et al.Best practice periextubation bundle reduces neonatal and infant extubation failure after cardiac surgery ［J］.Cardiol Young，2025，35（2）： 332-337.
26	Maisel AS，Krishnaswamy P，Nowak RM，et al.Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure［J］.N Engl J Med，2002，347（3）： 161-167.
27	Mori Y，Nakashima Y，Kaneko S，et al.Risk factors for cardiac adverse events in infants and children with complex heart disease scheduled for Bi-ventricular repair： prognostic value of pre-operative B-type natriuretic peptide and high-sensitivity troponin T ［J］.Pediatr Cardiol，2020，41（8）： 1756-1765.
28	包艳春，关秀军，邱虹.心衰伴肺部感染患者血清CHE、NTproBNP、PCT 水平与心功能的相关性及预后预测价值［J/OL］.中华临床医师杂志（电子版），2022，16（2）： 146-151.
29	Mehmood A，Ismail SR，Kabbani MS，et al.Outcome of low body weight （＜ 2.2 kg） infants undergoing cardiac surgery ［J］.J Saudi Heart Assoc，2014，26（3）： 132-137.

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