Lex Daniel J, Tóth Roland, Czobor Nikoletta R, Alexander Stephen I, Breuer Tamás, Sápi Erzsébet, Szatmári András, Székely Edgár, Gál János, Székely Andrea
1School of PhD Studies, Semmelweis University, Budapest, Hungary. 2Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia. 3Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary. 4Department of Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary. 5Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
Pediatr Crit Care Med. 2016 Apr;17(4):307-14. doi: 10.1097/PCC.0000000000000659.
Fluid overload after pediatric cardiac surgery is common and has been shown to increase both mortality and morbidity. This study explores the risk factors of early postoperative fluid overload and its relationship with adverse outcomes.
Secondary analysis of the prospectively collected data of children undergoing open-heart surgery between 2004 and 2008.
Tertiary national cardiac center.
One thousand five hundred twenty consecutive pediatric patients (<18 years old) were included in the analyses.
None.
In the first 72 hours of the postoperative period, the daily fluid balance was calculated as milliliter per kilogram and the daily fluid overload was calculated as fluid balance (L)/weight (kg) × 100. The primary endpoint was in-hospital mortality; the secondary outcomes were low cardiac output syndrome and prolonged mechanical ventilation. One thousand three hundred and sixty-seven patients (89.9%) had a cumulative fluid overload below 5%; 120 patients (7.8%), between 5% and 10%; and 33 patients (2.1%), above 10%. After multivariable analysis, higher fluid overload on the day of the surgery was independently associated with mortality (adjusted odds ratio, 1.14; 95% CI, 1.008-1.303; p = 0.041) and low cardiac output syndrome (adjusted odds ratio, 1.21; 95% CI, 1.12-1.30; p = 0.001). Higher maximum serum creatinine levels (adjusted odds ratio, 1.01; 95% CI, 1.003-1.021; p = 0.009), maximum vasoactive-inotropic scores (adjusted odds ratio, 1.01; 95% CI, 1.005-1.029; p = 0.042), and higher blood loss on the day of the surgery (adjusted odds ratio, 1.01; 95% CI, 1.004-1.025; p = 0.015) were associated with a higher risk of fluid overload that was greater than 5%.
Fluid overload in the early postoperative period was associated with higher mortality and morbidity. Risk factors for fluid overload include underlying kidney dysfunction, hemodynamic instability, and higher blood loss on the day of the surgery.
小儿心脏手术后液体超负荷很常见，且已证明会增加死亡率和发病率。本研究探讨术后早期液体超负荷的危险因素及其与不良结局的关系。
对2004年至2008年间接受心脏直视手术儿童的前瞻性收集数据进行二次分析。
国家三级心脏中心。
1520例连续的儿科患者（<18岁）纳入分析。
无。
在术后的前72小时，每日液体平衡按每千克毫升数计算，每日液体超负荷按液体平衡（升）/体重（千克）×100计算。主要终点是住院死亡率；次要结局是低心排血量综合征和机械通气时间延长。1367例患者（89.9%）累积液体超负荷低于5%；120例患者（7.8%），在5%至10%之间；33例患者（2.1%），高于10%。多变量分析后，手术当天较高的液体超负荷与死亡率（调整优势比，1.14；95%可信区间，1.008 - 1.303；p = 0.041）和低心排血量综合征（调整优势比，1.21；95%可信区间，1.12 - 1.30；p = 0.001）独立相关。较高的最高血清肌酐水平（调整优势比，1.01；95%可信区间，1.003 - 1.021；p = 0.009）、最高血管活性药物 - 正性肌力药物评分（调整优势比，1.01；95%可信区间，1.005 - 1.029；p = 0.042）以及手术当天较高的失血量（调整优势比，1.01；95%可信区间，1.004 - 1.025；p = 0.015）与液体超负荷大于5%的较高风险相关。
术后早期液体超负荷与较高的死亡率和发病率相关。液体超负荷的危险因素包括潜在的肾功能不全、血流动力学不稳定以及手术当天较高的失血量。
