From the Department of Anesthesiology and Perioperative Medicine, Division of Pediatric Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, California.
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
Anesth Analg. 2019 Oct;129(4):1079-1086. doi: 10.1213/ANE.0000000000003805.
Hypertrophic pyloric stenosis in infants can cause a buildup of gastric contents. Orogastric tubes (OGTs) or nasogastric tubes (NGTs) are often placed in patients with pyloric stenosis before surgical management to prevent aspiration. However, exacerbation of gastric losses may lead to electrolyte abnormalities that can delay surgery, and placement has been associated with increased risk of postoperative emesis. Currently, there are no evidence-based guidelines regarding OGT/NGT placement in these patients. This study examines whether OGT/NGT placement before arrival in the operating room was associated with a longer time to readiness for surgery as defined by normalization of electrolytes. Secondary outcomes included time from surgery to discharge and ability to tolerate feeds by 6 hours postoperatively in patients with and without early OGT/NGT placement.
In this multicenter retrospective cohort study, data were extracted from the medical records of 481 patients who underwent pyloromyotomy for infantile hypertrophic pyloric stenosis from March 2013 to June 2016. Multivariable linear regression and Cox proportional hazard models were constructed to evaluate the association between placement of an OGT/NGT at the time of admission with increased time to readiness for surgery (defined as the time from admission to the first set of normalized laboratory values) and increased time from surgery to discharge. Multivariable logistic regression was used to evaluate the association between early OGT/NGT placement and the ability to tolerate oral intake at 6 hours postsurgery. Analyses were adjusted for site differences.
Among patients admitted with electrolyte abnormalities, those with an OGT/NGT placed on presentation required more time until their serum electrolytes were at acceptable levels for surgery by regression analysis (19.2 hours difference; 95% confidence interval, 10.05-28.41; P < .001), after adjusting for site. Overall, patients who had OGTs/NGTs placed before presentation in the operating room had a longer length of stay from surgery to discharge than those without (38.8 hours difference; 95% confidence interval, 25.35-52.31; P < .001), after adjusting for site. OGT/NGT placement before surgery was not associated with failure to tolerate oral intake within 6 hours of surgery after adjusting for site, corrected gestational age, and baseline serum electrolytes.
OGT/NGT placement on admission for pyloric stenosis is associated with a longer time to electrolyte correction in infants with abnormal laboratory values on presentation and, subsequently, a longer time until they are ready for surgery. It is also associated with longer postoperative hospital stay but not an increased risk of feeding intolerance within 6 hours of surgical repair.
婴儿肥厚性幽门狭窄可导致胃内容物积聚。在进行手术治疗之前，通常会在患有幽门狭窄的患者中放置经口胃管（OGT）或经鼻胃管（NGT），以防止误吸。然而，胃损失的加剧可能导致电解质异常，从而延迟手术，并且放置与术后呕吐的风险增加有关。目前，尚无关于这些患者中放置 OGT/NGT 的循证指南。本研究检查了在手术室到达之前是否放置 OGT/NGT 是否与通过电解质正常化定义的手术准备时间更长有关。次要结果包括在有和没有早期 OGT/NGT 放置的患者中，从手术到出院的时间以及术后 6 小时内耐受喂养的能力。
在这项多中心回顾性队列研究中，从 2013 年 3 月至 2016 年 6 月期间，对 481 名接受幽门肌切开术治疗婴儿肥厚性幽门狭窄的患者的病历数据进行了提取。构建多变量线性回归和 Cox 比例风险模型，以评估在入院时放置 OGT/NGT 与手术准备时间（定义为从入院到首次获得正常实验室值的时间）之间的关系，以及从手术到出院的时间之间的关系。使用多变量逻辑回归评估早期 OGT/NGT 放置与术后 6 小时内口服摄入能力之间的关系。分析调整了地点差异。
在入院时电解质异常的患者中，通过回归分析，在就诊时放置 OGT/NGT 的患者需要更多的时间直到他们的血清电解质达到可接受的手术水平（19.2 小时差异；95%置信区间，10.05-28.41；P <.001），调整了地点差异。总体而言，与未放置 OGT/NGT 的患者相比，在手术室中放置 OGT/NGT 的患者从手术到出院的住院时间更长（38.8 小时差异；95%置信区间，25.35-52.31；P <.001），调整了地点差异。在调整了地点、校正胎龄和基线血清电解质后，手术前放置 OGT/NGT 与术后 6 小时内不能耐受口服摄入无关。
在入院时患有幽门狭窄的患者中，在入院时放置 OGT/NGT 与实验室值异常的婴儿中电解质纠正的时间更长，随后与手术准备时间更长有关。它还与术后住院时间延长有关，但与术后 6 小时内喂养不耐受的风险增加无关。
