Malviya Shobha, Voepel-Lewis Terri, Siewert Monica, Pandit Uma A, Riegger Lori Q, Tait Alan R
Department of Anesthesiology, The University of Michigan Health System, Ann Arbor 48109, USA.
Anesthesiology. 2003 Mar;98(3):628-32. doi: 10.1097/00000542-200303000-00009.
Otherwise healthy children who present for elective surgery with an upper respiratory infection (URI) may be at risk for perioperative respiratory complications. This risk may be increased in children with congenital heart disease who undergo cardiac surgery while harboring a URI because of their compromised cardiopulmonary status. Therefore, this study was designed to determine the incidence of peri- and postoperative complications in children undergoing cardiac surgery while harboring a URI.
The study population consisted of 713 children scheduled to undergo cardiac surgery. Of these, 96 had symptoms of URI, and 617 were asymptomatic. Children were followed prospectively from induction of anesthesia to discharge from the hospital to determine the incidence of postoperative respiratory, cardiovascular, neurologic, and surgical adverse events. Duration of postoperative ventilation, time in the intensive care unit (ICU), and length of hospital stay were also recorded.
Children with URIs had a significantly higher incidence of respiratory and multiple postoperative complications than children with no URIs (29.2 vs 17.3% and 25 vs 10.3%, respectively; P< 0.01) and a higher incidence of postoperative bacterial infections (5.2 vs 1.0%; P= 0.01). Furthermore, logistic regression indicated that the presence of a URI was an independent risk factor for multiple postoperative complications and postoperative infections in children undergoing open heart surgery. Children with URIs also stayed longer in the intensive care unit than children with no URIs (75.9 +/- 89.8 h vs 57.7 +/- 63.8, respectively; P< 0.01). However, the overall length of hospital stay was not significantly different (8.4 vs 7.8 days, URI vs non-URI groups; P> 0.05).
The presence of a URI was predictive of postoperative infection and multiple complications in children presenting for cardiac surgery. Despite this, the presence of a URI does not appear to affect the patient's overall length of hospital stay nor the development of long-term sequelae.
其他方面健康的儿童在患有上呼吸道感染（URI）时接受择期手术，可能面临围手术期呼吸并发症的风险。对于患有先天性心脏病且在患URI时接受心脏手术的儿童，由于其心肺功能受损，这种风险可能会增加。因此，本研究旨在确定患URI的儿童在接受心脏手术时围手术期和术后并发症的发生率。
研究人群包括713名计划接受心脏手术的儿童。其中，96名有URI症状，617名无症状。对儿童从麻醉诱导到出院进行前瞻性随访，以确定术后呼吸、心血管、神经和手术不良事件的发生率。还记录了术后通气时间、重症监护病房（ICU）停留时间和住院时间。
患有URI的儿童术后呼吸并发症和多种并发症的发生率显著高于无URI的儿童（分别为29.2%对17.3%和25%对10.3%；P<0.01），术后细菌感染的发生率也更高（分别为5.2%对1.0%；P = 0.01）。此外，逻辑回归表明，URI的存在是接受心脏直视手术儿童术后多种并发症和术后感染的独立危险因素。患有URI的儿童在重症监护病房的停留时间也比无URI的儿童更长（分别为75.9±89.8小时对57.7±63.8小时；P<0.01）。然而，总体住院时间没有显著差异（URI组对非URI组分别为8.4天对7.8天；P>0.05）。
URI的存在可预测接受心脏手术儿童的术后感染和多种并发症。尽管如此，URI的存在似乎并不影响患者的总体住院时间，也不影响长期后遗症的发生。
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