Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany.
Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
Eur J Cardiothorac Surg. 2019 Nov 1;56(5):904-910. doi: 10.1093/ejcts/ezz139.
Right ventricular pressure overload, which can result in restrictive right ventricular physiology, predicts slow recovery after biventricular repair of congenital heart defects. The goal of the study was to assess how extubation in the operating room influences the postoperative course in these patients.
Between January 2013 and June 2017, a total of 65 children [median age 0.96 (0.13-9.47) years; median weight 8 (3.05-25.8) kg] with right ventricular pressure overload underwent an intracardiac correction. The most common malformations were tetralogy of Fallot (n = 34) and double outlet right ventricle with pulmonary stenosis (n = 11). The patients were divided into 2 groups: the first (n = 36) comprised late extubated (LE) and the second (n = 29), early extubated (EE) children, immediately after chest closure in the operating room. Preoperative, perioperative and postoperative records were analysed retrospectively.
Children who had EE had a lower heart rate (EE 124.2 vs LE 133.6 bpm; P = 0.03), higher arterial blood pressure (systolic: EE 87.9 ± 9.35 vs LE 81.4 ± 12.0 mmHg; P = 0.029; diastolic: EE 51.1 ± 6.5 vs LE 45.9 ± 6.64 mmHg; P = 0.003), lower central venous pressure (EE 8.6 ± 1.89 mmHg vs LE 9.9 ± 2.42 mmHg; P = 0.03), fewer pleural effusions in the first 6 postoperative days (EE 1.38 ml/kg/day vs LE 5.98 ml/kg/day; P = 0.009), shorter time of dopamine support ≥3 μg/kg (EE 7.29 ± 12.26 h vs LE 34.78 ± 38.05 h, P < 0.001), shorter stays in the intensive care unit (EE 2.7 ± 2.67 vs LE 5.0 ± 4.77 days, P = 0.001) and hospital (EE 11.8 ± 4.79 vs LE 15.5 ± 7.8 days; P = 0.022).
Extubation in the operating room of children with right ventricular pressure overload undergoing biventricular correction is feasible and safe and has a beneficial effect on the postoperative course.
右心室压力超负荷可导致右心室限制性生理改变，这预示着先天性心脏缺陷的双心室修复后恢复缓慢。本研究的目的是评估在这些患者中，手术室拔管如何影响术后过程。
2013 年 1 月至 2017 年 6 月，共有 65 例右心室压力超负荷患儿（中位年龄 0.96（0.13-9.47）岁；中位体重 8（3.05-25.8）kg）接受了心脏内矫正术。最常见的畸形为法洛四联症（n=34）和双出口右心室伴肺动脉瓣狭窄（n=11）。将患者分为两组：第一组（n=36）为延迟拔管（LE）组，第二组（n=29）为早期拔管（EE）组，即在手术室关闭胸廓后立即拔管。回顾性分析术前、围术期和术后记录。
EE 组患儿心率较低（EE 124.2 比 LE 133.6 次/分；P=0.03），动脉血压较高（收缩压：EE 87.9±9.35 比 LE 81.4±12.0mmHg；P=0.029；舒张压：EE 51.1±6.5 比 LE 45.9±6.64mmHg；P=0.003），中心静脉压较低（EE 8.6±1.89mmHg 比 LE 9.9±2.42mmHg；P=0.03），术后第 6 天前胸腔积液较少（EE 1.38ml/kg/天比 LE 5.98ml/kg/天；P=0.009），多巴胺支持时间≥3μg/kg 较短（EE 7.29±12.26 小时比 LE 34.78±38.05 小时，P<0.001），重症监护病房入住时间较短（EE 2.7±2.67 比 LE 5.0±4.77 天，P=0.001），住院时间较短（EE 11.8±4.79 比 LE 15.5±7.8 天；P=0.022）。
对接受双心室矫正术的右心室压力超负荷患儿在手术室拔管是可行和安全的，并对术后过程有有益的影响。
