Taylor Dan, Habre Walid
Department of Paediatric Anaesthesia, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trusts, London, UK.
Paediatric Anaesthesia Unit, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
Paediatr Anaesth. 2019 May;29(5):426-434. doi: 10.1111/pan.13595. Epub 2019 May 2.
Database analysis has indicated that perioperative cardiac arrest occurs with increased frequency in children with congenital heart disease. Several case series and large datasets from ACS NSQIP have identified subgroups at the highest risk. Consistently, patients with single ventricle physiology (especially prior to cavopulmonary anastomosis), severe/supra-systemic pulmonary hypertension, complex lesions, and cardiomyopathy with significantly reduced ventricular function have been shown to be at increased risk for adverse events. Based on these results, algorithms for assessing risk have been proposed. How hospitals and health care systems apply these guidelines to provide safe care for these challenging patient groups requires the application of modern quality improvement techniques. Each institution should develop a system which reflects local expertise and resources.
数据库分析表明，先天性心脏病患儿围手术期心脏骤停的发生率更高。美国外科医师学会国家外科质量改进计划（ACS NSQIP）的几个病例系列和大型数据集已确定了风险最高的亚组。一直以来，单心室生理状态（尤其是在腔肺吻合术前）、重度/系统性肺动脉高压、复杂病变以及心室功能显著降低的心肌病患者发生不良事件的风险更高。基于这些结果，已提出了风险评估算法。医院和医疗保健系统如何应用这些指南为这些具有挑战性的患者群体提供安全的护理，需要应用现代质量改进技术。每个机构都应建立一个反映当地专业知识和资源的系统。
