Impact of delayed diagnosis time on post-surgery recovery in 0 – 18 years old congenital heart disease patients in 8 western provinces of China: a comparative analysis
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摘要:
目的 探讨儿童先天性心脏病(CHD)不同延迟诊断时长与患者术后康复结果的关系,为针对性的先心病早期筛查和治疗提供依据。 方法 于2017年1月 — 2020年12月,选取在云南省阜外心血管病医院接受治疗的来自8个省2879例 ≤ 18岁先心病患者为研究对象,采用横断面调查结合回顾性调查方法,收集患者电子病历并随访术后“身体 – 心理 – 社会适应”等信息,分析不同延迟诊断时长与术后康复结果的关系。 结果 2879例研究对象中,先心病延迟诊断1 908例(66.3 %),延迟诊断0.03~3年、3.01~7.5年、> 7.5年分别有663例(23.0 %)、615例(21.4 %)、630例(21.9 %)。延迟诊断0.03~3年患儿生长发育较慢(19.7 %),且较难融入集体生活(28.0 %);延迟诊断时长 > 7.5年组患儿出现消极情绪的比例最高(17.4 %)。多因素非条件 logistic 回归分析结果显示,在调整了患儿性别、年龄、民族、CHD病种、家庭结构等相关因素后,与CHD延迟诊断时长 > 7.5年相比,延迟诊断0.03~3年(OR = 0.685,95 % CI = 0.499~0.940)和3.01~7.5年(OR = 0.630,95 % CI = 0.450~0.882)均使患儿术后产生悲伤难过等消极情绪的风险降低。与延迟诊断0.03~3年相比,延迟诊断0年(OR = 0.717,95 % CI = 0.563~0.914)和 > 7.5年(OR = 0.685,95 % CI = 0.528~0.888)均使患儿术后难以融入集体生活的风险降低。 结论 儿童先天性心脏病不同延迟诊断时长会对术后康复结果产生影响,CHD延迟诊断时长 > 7.5年与患儿术后产生消极情绪有关,延迟诊断0.03~3年与术后难以融入集体生活有关。 Abstract:Objective To explore the association of delayed diagnosis time with post-surgery recovery in children with congenital heart disease (CHD) for providing evidences to effective early screening and treatment of CHD. Methods From January 2017 to December 2020, a CHD screening program was conducted among 3 015 470 students from 7 783 schools in 8 provincial-level regions in western China and totally 3 805 diagnosed CHD patients were surgically treated at Fuwai Yunnan Cardiovascular Hospital and followed up for post-treatment management. Medical records and information on physical-psychological-social adaptation of the CHD patients aged 0 – 18 years were collected and analyzed to assess the correlation between delayed diagnosis time and post-surgery recovery in the child patients. Results Of the 2 879 child patients included in the analysis, 66.3% (1 908) had delayed diagnosis of CHD and 23.0% (663), 21.4% (615), and 21.9% (630) had delayed diagnosis time of 0.03 – 3 years, 3.01 – 7.5 years, and longer than 7.5 years, respectively. Among the child patients with delayed diagnosis time of 0.03 – 3 years, 19.7% had developmental retardation and 28.0% had difficulty in group living; of the child patients with the delayed diagnosed time longer than 7.5 years, 17.4% were assessed being prone to have negative emotion. After adjusting for gender, age, ethnics, type of CHD, and family structure, the results of multivariate logistic regression analysis demonstrated that compared to those with the delayed diagnosis time of longer than 7.5 years, the child patients with shorter delayed diagnosis time were at a decreased the risk of post-surgery negative emotion with the odds ratio (OR) of 0.685 (95% confidence interval [95% CI]: 0.499 – 0.940) for those with the time of 0.03 – 3 years and the OR of 0.630 (95% CI: 0.450 – 0.882) for those with the time of 3.01 – 7.5 years; while, compared to those with the delayed diagnosis time of 0.03 – 3 years, the child patients being timely diagnosed and the patients with the delayed diagnosis time longer than 7.5 years were at a decreased risk of having difficulty in group living, with the OR of 0.717 (95% CI: 0.563 – 0.914) and OR of 0.685 (95% CI: 0.528 – 0.888), respectively. Conclusion Among child patients having surgery treatment, the delayed time of CHD diagnosis can influence post-surgery recovery; the delayed diagnosis time of 7.5 years is associated with the incidence of post-surgery negative emotion and that of 0.03 – 3 years is related to having difficulty in group living after surgery treatment. -
Key words:
- congenital heart disease /
- delayed diagnosis time /
- post-surgery recovery /
- comparison
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表 1 CHD不同延迟诊断时长组患儿基本情况
基本特征 总例数 延迟诊断0年 延迟诊断0.03~3年 延迟诊断3.01~7.5年 延迟诊断 > 7.5年 χ2 值 P 值 例数 % 例数 % 例数 % 例数 % 性别 1.689 0.639 男性 1250 411 42.3 301 45.4 269 43.7 269 42.7 女性 1629 560 57.7 362 54.6 346 56.3 361 57.3 年龄(岁) 2747.741 < 0.001 < 3 1245 807 83.1 438 66.1 0 0.0 0 0.0 4~8 701 164 16.9 162 24.4 368 59.8 7 1.1 > 8 933 0 0.0 63 9.5 247 40.2 623 98.9 民族 11.186 0.263 汉族 1996 683 70.3 450 67.9 426 69.3 437 69.4 彝族 273 89 9.2 54 8.1 66 10.7 64 10.2 苗族 91 24 2.5 22 3.3 26 4.2 19 3.0 其他少数民族 519 175 18.0 137 20.7 97 15.8 110 17.5 年满7岁就学情况 337.877 < 0.001 未上学 128 0 0.0 44 23.8 26 6.5 58 9.2 小学 507 0 0.0 127 68.6 238 59.8 142 22.5 初中 337 0 0.0 13 7.0 112 28.1 212 33.7 高中及以上 241 0 0.0 1 0.5 12 5.5 218 34.6 CHD病种 300.184 < 0.001 房间隔缺损 1155 554 57.1 184 27.8 241 39.2 176 27.9 室间隔缺损 1012 262 27.0 286 43.1 212 34.5 252 40.0 肺动脉瓣狭窄 55 3 0.3 21 3.2 9 1.5 22 3.5 动脉导管未闭 438 108 11.1 97 14.6 122 19.8 111 17.6 法洛四联症 62 36 3.7 13 2.0 5 0.8 8 1.3 卵圆孔未闭 23 1 0.1 8 1.2 5 0.8 9 1.4 其他复杂病种 134 7 0.7 54 8.1 21 3.4 52 8.3 表 2 CHD不同诊断延迟时长患儿术后康复情况比较
变量 总例数 延迟诊断0年 延迟诊断0.03~3年 延迟诊断3.01~7.5年 延迟诊断 > 7.5年 χ2 值 P 值 例数 % 例数 % 例数 % 例数 % 生长发育情况(与同龄人相比) 22.710 0.001 较慢 466 178 19.2 126 19.7 80 ab 13.3 82 ab 13.3 一致 2204 703 75.9 495 77.2 501 ab 83.4 505 a 82.1 较快 113 45 4.9 20 3.1 20 3.3 28 4.6 饮食/喂食是否异常 10.110 0.018 是 638 237 25.6 155 24.2 115 a 19.1 131 21.3 否 2145 689 74.4 486 75.8 486 a 80.9 484 78.7 是否难以融入集体生活 11.761 0.008 是 651 196 21.2 184 a 28.0 140 23.2 131 b 21.3 否 2151 730 78.0 474 a 72.0 463 76.8 484 b 78.7 术后是否产生消极情绪 12.420 0.006 是 373 115 12.4 83 12.9 66 11.0 109 ac 17.4 否 2423 811 87.6 558 87.1 535 89.0 519 ac 82.6 是否呼吸困难 2.996 0.392 是 105 36 4.4 20 3.6 20 3.6 29 5.4 否 2351 775 95.6 541 96.4 529 96.4 506 94.6 体力是否难以改善 2.715 0.438 是 501 150 18.5 119 21.2 117 21.3 115 21.5 否 1955 661 81.5 442 78.8 432 78.7 420 78.5 是否需要二期手术 4.214 0.239 是 92 38 4.7 20 3.6 14 2.6 20 3.7 否 2364 773 95.3 541 96.4 535 97.4 515 96.3 注:与延迟诊断0年组比较,a P < 0.5;与延迟诊断0.03~3年组比较,b P < 0.5;与延迟诊断3.01~7.5年组比较,c P < 0.5。 表 3 CHD不同延迟诊断时长与患儿术后康复结果的logistic回归分析
模型 因素 比较组 参照组 β $S_{\bar x}$ Wald χ2 值 P 值 OR 值 95 % CI 模型一 CHD病种 肺动脉瓣狭窄 房间隔缺损 0.727 0.339 4.606 0.032 2.070 1.065~4.022 其他复杂病种 1.051 0.223 22.197 < 0.001 2.861 1.847~4.430 民族 苗族 汉族 1.033 0.248 17.339 < 0.001 2.809 1.727~4.567 延迟诊断时长 延迟诊断0.03~3年 延迟诊断 > 7.5年 – 0.378 0.161 5.487 0.019 0.685 0.499~0.940 延诊断迟3.01~7.5年 – 0.462 0.172 7.259 0.007 0.630 0.450~0.882 模型二 CHD病种 动脉导管未闭 房间隔缺损 0.312 0.132 5.544 0.019 1.366 1.054~1.771 其他复杂病种 0.435 0.210 4.295 0.038 1.544 1.024~2.329 延迟诊断时长 延迟诊断0年 延迟诊断0.03~3年 – 0.332 0.124 7.244 0.007 0.717 0.563~0.914 延迟诊断 > 7.5年 – 0.378 0.133 8.146 0.004 0.685 0.528~0.888 -
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