Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.
College of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee.
J Surg Res. 2019 Oct;242:336-341. doi: 10.1016/j.jss.2019.04.077. Epub 2019 May 23.
Individuals with sickle cell disease (SCD) are at high risk of developing life-threatening complications, particularly acute chest syndrome (ACS) postoperatively. The perioperative factors associated with the development of ACS in children with SCD after splenectomy have not been clearly identified.
We retrospectively reviewed medical records of all children who underwent splenectomy at our institution between 1997 and 2017 with the goal of identifying perioperative factors associated with postoperative ACS. Categorical and noncategorical variables were compared using Fisher's exact test and Student's two-tailed t-test, respectively.
Sixty-five patients with SCD underwent splenectomy at a median of 4.0 (interquartile range [IQR] 2.0-8.0) years of age. A laparoscopic approach was used for 64 (98.5%) patients. Fifty-six (86.2%) underwent laparoscopic total splenectomy, and eight (12.3%) underwent laparoscopic partial splenectomy, of which two were converted to open. One had an open partial splenectomy (1.5%). Of the 65 patients, 10 (15.4%) developed ACS with a mean time to diagnosis of 49.0 ± 34.5 h. Children who developed ACS had a higher postoperative median pain score of 6.8 (IQR 5.1-9.1) versus 2.7 (IQR 1.6-4.2), P < 0.001, higher median pain score area under the curve 111.5 (IQR 76.9-169.1) versus 47.3 (IQR 30.5-78.3), P = 0.01, and received more total morphine equivalents (median 1.4 [IQR 0.4-2.7] versus 0.5 [IQR 0.3-0.9] mg/kg, respectively; P = 0.003), compared with children who did not develop ACS.
Significant postoperative pain may be an early sign of ACS that could be worsened by opioid use, supporting the investigation of nonopioid pain control options in this patient population.
镰状细胞病（SCD）患者有发生危及生命的并发症的高风险，尤其是术后急性胸部综合征（ACS）。SCD 患者脾切除术后发生 ACS 的围手术期相关因素尚未明确。
我们对 1997 年至 2017 年间在我院接受脾切除术的所有 SCD 患儿的病历进行了回顾性分析，目的是确定与术后 ACS 相关的围手术期因素。分别采用 Fisher 确切检验和学生双尾 t 检验比较分类变量和非分类变量。
65 例 SCD 患儿在中位年龄 4.0（四分位距 [IQR] 2.0-8.0）岁时接受了脾切除术。64 例（98.5%）采用腹腔镜入路。56 例行腹腔镜全脾切除术，8 例行腹腔镜脾部分切除术，其中 2 例转为开腹。1 例开腹脾部分切除术（1.5%）。65 例患儿中，10 例（15.4%）发生 ACS，平均诊断时间为 49.0±34.5 h。发生 ACS 的患儿术后中位数疼痛评分更高，为 6.8（IQR 5.1-9.1），而未发生 ACS 的患儿为 2.7（IQR 1.6-4.2），P<0.001；疼痛评分曲线下面积中位数也更高，分别为 111.5（IQR 76.9-169.1）和 47.3（IQR 30.5-78.3），P=0.01；接受的吗啡等效物总量中位数也更高，分别为 1.4（IQR 0.4-2.7）和 0.5（IQR 0.3-0.9）mg/kg，P=0.003。
术后显著疼痛可能是 ACS 的早期征象，阿片类药物的使用可能会使疼痛恶化，这支持在该患者群体中探索非阿片类药物的疼痛控制选择。
