青少年特发性脊柱侧弯后路脊柱融合术后谁需要儿科重症监护病房？

Who Needs a Pediatric Intensive Care Unit After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis?

作者信息

Haber Lawrence L, Womack Erika D, Sathyamoorthy Madhankumar, Moss James A, Shrader Michael Wade

机构信息

Department of Orthopaedic Surgery, Ochsner Hospital for Children, 1514 Jefferson Hwy, New Orleans, LA 70121, USA.

Department of Orthopaedic Surgery, University of Mississippi Center, 2500 N State St, Jackson, MS 39216, USA.

出版信息

Spine Deform. 2018 Mar-Apr;6(2):137-140. doi: 10.1016/j.jspd.2017.08.006. Epub 2017 Oct 5.

DOI:10.1016/j.jspd.2017.08.006

PMID:29413735

Abstract

BACKGROUND

Hypotensive events (HEs) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can lead to delayed neurologic postoperative deficits (DNPD). This study aimed to determine the incidence of HEs (mean arterial pressure [MAP] <60 mmHg) after PSF for AIS and identify predictors for HEs.

METHODS

Medical records of 99 consecutive patients who had PSF for AIS were retrospectively reviewed (2011-2013). Perioperative data were collected. Patients were divided into two groups based on MAP readings by an arterial line in the pediatric intensive care unit immediately postoperatively into postoperative day one: Group 1 (MAP ≥60 mmHg) and Group 2 (multiple occurrences of MAPs <60 mmHg). Mean values were compared using the independent t test. Multiple logistic regression was used to estimate the association of preoperative and intraoperative parameters with multiple HEs.

RESULTS

Group 1 had 68 patients (68.7%) and Group 2 had 31 patients (31.3%). None of the compared parameters were associated significantly with multiple HE. However, patients who did not exhibit HEs within the first four hours postoperatively remained stable throughout the rest of the postoperative period. Only those with HEs in the first four hours experienced subsequent HEs in the first 24 hours. There were no DNPD or other major complications.

CONCLUSION

Results showed that the incidence of HEs after PSF in AIS can be as high as 31.3%. We did not find any significant risk factors. Although DNPD after PSF is a rare complication and we had none in this series, we suggest that these patients with multiple HEs may be at risk for DNPD as a result of hypotension and potential for cord ischemia. Therefore, all patients after PSF should be monitored in a pediatric intensive care unit-type environment or postanesthesia recovery room initially. If stable for, at least, the initial four hours, then patients should be good candidates for a less intensive environment.

LEVEL OF EVIDENCE

Level 3.

摘要

背景

青少年特发性脊柱侧弯（AIS）后路脊柱融合术（PSF）后发生的低血压事件（HEs）可导致术后迟发性神经功能缺损（DNPD）。本研究旨在确定AIS行PSF后HEs（平均动脉压[MAP]<60 mmHg）的发生率，并确定HEs的预测因素。

方法

回顾性分析99例连续接受AIS后路脊柱融合术患者的病历（2011 - 2013年）。收集围手术期数据。根据术后即刻至术后第1天在儿科重症监护病房通过动脉导管测得的MAP读数将患者分为两组：第1组（MAP≥60 mmHg）和第2组（多次出现MAP<60 mmHg）。采用独立t检验比较均值。采用多因素logistic回归分析术前和术中参数与多次发生HEs的相关性。

结果

第1组有68例患者（68.7%），第2组有31例患者（31.3%）。所比较的参数均与多次发生HEs无显著相关性。然而，术后前4小时未出现HEs的患者在术后其余时间保持稳定。仅那些在前4小时出现HEs的患者在术后24小时内出现后续HEs。未发生DNPD或其他主要并发症。

结论

结果表明，AIS行PSF后HEs的发生率可高达31.3%。我们未发现任何显著的危险因素。虽然PSF后DNPD是一种罕见的并发症，且本系列中未发生，但我们认为这些多次发生HEs的患者可能因低血压和脊髓缺血风险而有发生DNPD的风险。因此，所有PSF术后患者最初应在儿科重症监护病房类型的环境或麻醉后恢复室进行监测。如果至少在最初4小时内保持稳定，那么患者适合在强度较低的环境中。