Mastro-Martínez Ignacio, Iglesias-Bouzas Maria I, Cabeza Martin Beatriz, Oñoro-Otero Gonzalo, Perez-Diaz Carlos, Serrano-Gonzalez Ana, Casado-Flores Juan
Pediatric Intensive Care Unit, Niño Jesús University Hospital, Madrid, Spain -
Pediatric Intensive Care Unit, Niño Jesús University Hospital, Madrid, Spain.
Minerva Pediatr. 2017 Oct;69(5):381-390. doi: 10.23736/S0026-4946.16.04277-8. Epub 2015 Sep 1.
The aim of this study was to describe the complications experienced by patients after central nervous system tumor resection during pediatric intensive care Unit (PICU) admission. Our attempt was to assess the association between epidemiological, clinical data and tumor characteristics prior to surgery and presence of postoperative complications.
We design an observational, descriptive and retrospective study by review of medical records. Patients aged 0-18 years, admitted to the PICU of our hospital, after surgery for tumor resection in the central nervous system.
We collected a total of 145 postoperative. At PICU, 48.3% of the patients (70/145) had some type of postoperative complication. It they were, in order of frequency: a new neurological deficit at discharge (29%, 42/145), pneumocephalus (21%, 30/145), electrolyte disturbances (17.9%, 26), infection (16.6%, 24), anemia (8.3%, 12), seizures (7.6%, 11), endocrine disorders (7.6%, 11), intracranial hypertension (5.5%, 8) and stroke (7, 4.8%). One patient died. There was no difference in overall complication and the tumor site. However, supratentorial tumors had less need for MV (73% vs. 92%, P=0.002, OR 2.7 [1.2-6.1]), shorter duration for MV (11 hours vs. 48 hours, P=0.02), lower frequency of neurological deficit (22% vs. 37%, P=0.004, OR 1.4 [1-2.1]) and cerebrospinal fluid fistula (1% vs. 13%, P=0.004, OR 2.1 [1.6- 2.8]). They were more frequent seizures (13% vs. 2%, P=0.024, OR 1.8 [1.4-2.3]), central diabetes insipidus (17% vs. 0%, P<0.001, OR 4.3 [1.6-11.7]) and endocrine disruption (14% vs. 0%, P=0.001, OR 2 [1.7-2.4]).
The intracranial tumors surgery requires monitoring in intensive care because the risk of postoperative complications is high. The tumor location is related to the occurrence of some of these complications.
本研究的目的是描述小儿重症监护病房（PICU）收治的中枢神经系统肿瘤切除术后患者所经历的并发症。我们试图评估术前的流行病学、临床数据和肿瘤特征与术后并发症发生之间的关联。
我们通过回顾病历设计了一项观察性、描述性和回顾性研究。研究对象为0至18岁、在我院PICU接受中枢神经系统肿瘤切除术后的患者。
我们共收集了145例术后患者的数据。在PICU，48.3%的患者（70/145）出现了某种类型的术后并发症。按发生频率依次为：出院时出现新的神经功能缺损（29%，42/145）、气颅（21%，30/145）、电解质紊乱（17.9%，26例）、感染（16.6%，24例）、贫血（8.3%，12例）、癫痫发作（7.6%，11例）、内分泌紊乱（7.6%，11例）、颅内高压（5.5%，8例）和中风（7例，4.8%）。1例患者死亡。总体并发症与肿瘤部位之间无差异。然而，幕上肿瘤患者机械通气需求较少（73%对92%，P = 0.002，OR 2.7 [1.2 - 6.1]），机械通气持续时间较短（11小时对48小时，P = 0.02），神经功能缺损频率较低（22%对37%，P = 0.004，OR 1.4 [1 - 2.1]），脑脊液漏发生率较低（1%对13%，P = 0.004，OR 2.1 [1.6 - 2.8]）。幕上肿瘤患者癫痫发作（13%对2%，P = 0.024，OR 1.8 [1.4 - 2.3]）、中枢性尿崩症（17%对0%，P < 0.001，OR 4.3 [1.6 - 11.7]）和内分泌紊乱（14%对0%，P = 0.001，OR 2 [1.7 - 2.4]）更为常见。
颅内肿瘤手术需要在重症监护下进行监测，因为术后并发症风险较高。肿瘤位置与其中一些并发症的发生有关。
