影響兒童先天性心臟病死亡率之分析—以大動脈轉位類型為例

目的：大動脈轉位屬於嚴重發紺型先天性心臟病，病童需及早完成矯正手術才得以順利存活，手術有其複雜度及死亡高風險，可做為小兒心臟醫療照顧品質的參考。如能暸解臺灣大動脈轉位兒童整體死亡率及接受動脈矯正手術的死亡率及其相關影響因子。對小兒心臟醫療照顧指標基準的建立、減少大動脈轉位兒童家庭的不確定感及衛生社會機關擬定後續照顧政策的參考，都有很大的助益。方法：利用全民健康保險資料庫1997年至2009年的住院資料檔，擷取出所有大動脈轉位病童的住院資料，僅有大動脈轉位診斷或同時合併心房中隔缺損、開放動脈導管，則定義為「單純」，若合併其他先天性心臟病，則定義為「複雜」；另外選取性別、年齡、醫院經驗為變項。再依出院轉歸代碼及退保別判定死亡，進行死亡率及相關因子之分析。結果：大動脈轉位是兒童發紺型先天性心臟病中發生率第二高，執行動脈矯正手術的最佳時機是出生一個月內。整體大動脈轉位病童死亡與處置年齡、疾病複雜度有關；大動脈轉位病童接受動脈矯正手術死亡率與醫療機構經驗有關。結論：大動脈轉位病童住院處置時年齡較小、疾病程度單純，死亡率較低；另外在較具經驗醫院接受動脈矯正手術，死亡率較低。

關鍵字

先天性心臟病；死亡率；健康保險

並列摘要

OBJECTIVE: The transposition of greater arteries (TGA) was the severe cyanotic congenital heart disease. The children with TGA survived after receiving Arterial Switch Operation (ASO) early. There were complexity and high risk of mortality within ASO procedure and the mortality rate of ASO could be the care quality of pediatric cardiology. To understand the mortality and influencing factors of the children with TGA could establish the care quality level of pediatric cardiology, decrease the uncertain sense of family and formulate the care policy in Taiwan. METHOD: This was a population-based study using administrative data from the secondary database of the Bureau of National Health Insurance. A retrospective cohort design was employed to identify the TGA infants hospitalized during the period of 1997-2009. The cases enrolled into this study were compatible with a diagnosis of TGA according to the ICD-9 classification. The TGA patients associated with ASD and/or PDA are defined as ‘simple TGA’, while those associated with other complex CHDs are defined as ‘complex TGA’. The gender, age and institutional experience were classified as variables. We analyzed the mortality and the influencing factors by the discharge situation of the hospital and the insurance termination date of children. RESULTS: The TGA is the second most common cyanotic congenital heart disease in children. The most optimal timing for ASO is within one month of life. The mortality of TGA was significantly related to age, complexity of disease. The operative mortality of ASO procedure was significantly related to institutional experience. CONCLUSION: The survival of children with TGA was influenced by younger age, simple disease, and the survival of children receiving ASO was influenced by the institution experience.

並列關鍵字

Health Insurance ； Congenital Heart Disease ； Mortality

參考文獻

Harkel, A. D. J. T., & Takken, T. (2010). Exercise Testing and Prescription in Patients with Congenital Heart Disease. International Journal of Pediatrics,8,1-9

Donofrio, M. T., & Massaro, A. N. (2010). Impact of Congenital Heart Disease on Brain Development and Neurodevelopmental Outcome. International Journal of Pediatrics,8,1-13

許國正(2005)。先天性心臟病患童父母於開心手術前後需求之探討。慈濟護理雜誌，4(4)，40-48。

李淑莉、陳月枝(2001)。兒童經歷開心手術治療過程母親的壓力源及因應行為。護理研究，9(2)，172-181。

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延伸閱讀

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影響兒童先天性心臟病死亡率之分析—以大動脈轉位類型為例

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