Agnoletti Gabriella, Bonnet Caroline, Boudjemline Younes, Le Bihan Christine, Bonnet Damien, Sidi Daniel, Bonhoeffer Philipp
Service de Cardiologie Pédiatrique, Necker Enfants Malades, Paris, France.
Cardiol Young. 2005 Aug;15(4):402-8. doi: 10.1017/S1047951105000843.
To identify predictive factors of complications occurring during paediatric interventional catheterisation.
Interventional paediatric catheterisation is still burdened by a substantial risk. Risk factors, however, have rarely been investigated.
We analysed prospectively 1,022 interventional procedures performed over a period of 8 years, excluding 260 procedures for atrial septostomy. We considered several patient-related variables, specifically age, weight, and gender, type of procedure, times required for fluoroscopy and the overall procedure, technical challenge, and the severity of the clinical condition. We also analysed variables linked to the environment, specifically the date of the examination, whether the operator remained in training, the novelty of the material, any breakdown in the installation, and errors made by the operator. We classified complications as those without clinical consequence, those which proved lethal, those requiring cardiopulmonary resuscitation, elective or emergency surgery, hospitalisation in the intensive care unit, and those leading to recatheterisation.
Our average incidence of complications was 4.1 per cent, which did not change significantly during the period of study. Of the patients, 4 died, 7 needed urgent surgery, 5 elective surgery, 3 hospitalisation in intensive care unit, and 8 recatheterisation. Independent risk factors for complications were technical challenge, critical clinical condition, operator in training, operator error, and breakdown of the installation. Young age was not associated with a higher risk of complications. Patients in whom no cause for complication could be found, either related to their own features or the environment, had a risk of complication of 1.4 per cent (95 per cent confidence intervals from 0.7 to 2.5 per cent).
Our data show that variables relating either to the patient or the environment of catheterisation are associated with an increased risk of procedural complications. Knowledge of the risk factors can improve the odds of paediatric interventional catheterisation.
确定小儿介入导管插入术中发生并发症的预测因素。
小儿介入导管插入术仍面临重大风险。然而，危险因素很少得到研究。
我们对8年内进行的1022例介入手术进行了前瞻性分析，排除了260例房间隔造口术。我们考虑了几个与患者相关的变量，特别是年龄、体重和性别、手术类型、透视和整个手术所需时间、技术难度以及临床病情的严重程度。我们还分析了与环境相关的变量，特别是检查日期、操作者是否仍在培训、材料的新颖性、设备故障以及操作者的失误。我们将并发症分为无临床后果的并发症、致命的并发症、需要心肺复苏的并发症、择期或急诊手术、重症监护病房住院以及导致再次导管插入术的并发症。
我们的并发症平均发生率为4.1%，在研究期间没有显著变化。患者中，4人死亡，7人需要紧急手术，5人需要择期手术，3人在重症监护病房住院，8人需要再次导管插入术。并发症的独立危险因素是技术难度、严重临床病情、培训中的操作者、操作者失误和设备故障。年龄小与并发症风险较高无关。在那些找不到与自身特征或环境相关的并发症原因的患者中，并发症风险为1.4%（95%置信区间为0.7%至2.5%）。
我们的数据表明，与患者或导管插入术环境相关的变量与手术并发症风险增加有关。了解危险因素可以提高小儿介入导管插入术的成功率。
