Mastropietro Christopher W, Benneyworth Brian D, Turrentine Mark, Wallace Amelia S, Hornik Christoph P, Jacobs Jeffrey P, Jacobs Marshall L
Riley Hospital for Children, Indianapolis, Indiana; Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Riley Hospital for Children, Indianapolis, Indiana; Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Ann Thorac Surg. 2016 Jun;101(6):2285-92. doi: 10.1016/j.athoracsur.2016.01.046. Epub 2016 Apr 12.
Information concerning tracheostomy after operations for congenital heart disease has come primarily from single-center reports. We aimed to describe the epidemiology and outcomes associated with postoperative tracheostomy in a multi-institutional registry.
The Society of Thoracic Surgeons Congenital Heart Database (2000 to 2014) was queried for all index operations with the adverse event "postoperative tracheostomy" or "respiratory failure, requiring tracheostomy." Patients with preoperative tracheostomy or weighing less than 2.5 kg undergoing isolated closure of patent ductus arteriosus were excluded. Trends in tracheostomy incidence over time from January 2000 to June 2014 were analyzed with a Cochran-Armitage test. The patient characteristics associated with operative mortality were analyzed for January 2010 to June 2014, including deaths occurring up to 6 months after transfer of patients to long-term care facilities.
From 2000 to 2014, the incidence of tracheostomy after operations for congenital heart disease increased from 0.11% in 2000 to a high of 0.76% in 2012 (p < 0.0001). From 2010 to 2014, 648 patients underwent tracheostomy. The median age at operation was 2.5 months (25th, 75th percentile: 0.4, 7). Prematurity (n = 165, 26%), genetic abnormalities (n = 298, 46%), and preoperative mechanical ventilation (n = 275, 43%) were common. Postoperative adverse events were also common, including cardiac arrest (n = 131, 20%), extracorporeal support (n = 87, 13%), phrenic or laryngeal nerve injury (n = 114, 18%), and neurologic deficit (n = 51, 8%). The operative mortality was 25% (n = 153).
Tracheostomy as an adverse event of operations for congenital heart disease remains rare but has been increasingly used over the past 15 years. This trend and the considerable mortality risk among patients requiring postoperative tracheostomy support the need for further research in this complex population.
关于先天性心脏病手术后气管切开术的信息主要来自单中心报告。我们旨在描述多机构登记中与术后气管切开术相关的流行病学和结果。
查询胸外科医师协会先天性心脏病数据库（2000年至2014年）中所有伴有不良事件“术后气管切开术”或“呼吸衰竭，需气管切开术”的初次手术。排除术前已行气管切开术或体重小于2.5kg且仅接受动脉导管未闭封堵术的患者。采用 Cochr an-Armitage检验分析2000年1月至2014年6月期间气管切开术发生率随时间的变化趋势。分析2010年1月至2014年6月与手术死亡率相关的患者特征，包括患者转至长期护理机构后6个月内发生的死亡。
2000年至2014年，先天性心脏病手术后气管切开术的发生率从2000年的0.11%增至2012年的最高值0.76%（p<0.0001）。2010年至2014年，648例患者接受了气管切开术。手术时的中位年龄为2.5个月（第25、75百分位数：0.4，7）。早产（n = 165，26%）、遗传异常（n = 298，46%）和术前机械通气（n = 275，43%）很常见。术后不良事件也很常见，包括心脏骤停（n = 131，20%）、体外支持（n = 87，13%）、膈神经或喉返神经损伤（n = 114，18%）和神经功能缺损（n = 51，8%）。手术死亡率为25%（n = 153）。
气管切开术作为先天性心脏病手术的不良事件仍然少见，但在过去15年中使用越来越多。这种趋势以及术后需要气管切开术支持的患者中存在的相当大的死亡风险，支持在这一复杂人群中开展进一步研究的必要性。
