一种新的肺部超声评分对预测儿科心脏手术中 ICU 入住的预后价值。
Prognostic Value of a New Lung Ultrasound Score to Predict Intensive Care Unit Stay in Pediatric Cardiac Surgery.
机构信息
Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy; Institute of Clinical Physiology, National Research Institute, Pisa, Italy.
Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
出版信息
Ann Thorac Surg. 2020 Jan;109(1):178-184. doi: 10.1016/j.athoracsur.2019.06.057. Epub 2019 Aug 7.
BACKGROUND
Lung ultrasound (LUS) in pediatric cardiac surgery is gaining consensus. We (1) evaluated the prognostic value of a new LUS-score in pediatric cardiac surgery, and (2) compared LUS-score to conventional risk factors including age, The Society of Thoracic Surgeons/European Association of Cardio-Thoracic Surgery (STAT) score, cardiopulmonary bypass time, and prognostic biomarkers including brain natriuretic peptide and cystatin-C.
METHODS
LUS examinations were performed in 237 children (median age, 0.55 years; interquartile range, 0.09-4.15 years) at 12 to 36 hours after surgery. For each hemithorax, 3 areas (anterior/lateral/posterior) were evaluated in the upper and lower halves, constituting 12 total scanning areas. For each site a score was assigned: 0 (rare B lines), 1 (separated B lines), 2 (coalescent B lines), 3 (loss of aeration), and total LUS score was calculated as sum of all sites. The primary endpoints were intensive care unit length of stay and extubation time.
RESULTS
The mean total LUS score was 12.88 ± 6.41 (range, 0-26) and was higher in newborns (16.77 ± 5.25) compared with older children (5.36 ± 5.57; P < .001). On univariate analysis, LUS score was associated inversely with age (beta 0.26; P = .004) and body surface area (beta 3.41 P = .006) and positively with brain natriuretic peptide (beta 1.65; P < .001) and cystatin-C (beta 2.41; P < .001). The LUS score, when added as continuous predictor to a conventional risk model (age, STAT score, and cardiopulmonary bypass time) emerged significant both for intensive care unit length of stay (beta 0.145, P = .047) and extubation time (beta 1.644; P = .024). When single quadrants were analyzed, only anterior LUS score was significant (intensive care unit length of stay beta, 0.471; P = .020; extubation time beta 5.530; P = .007).
CONCLUSIONS
Our data show the prognostic incremental value of a new LUS score over traditional risk factors in pediatric cardiac surgery.
背景
肺部超声（LUS）在儿科心脏手术中越来越受到认可。我们（1）评估了一种新的 LUS 评分在儿科心脏手术中的预后价值，（2）将 LUS 评分与传统危险因素（包括年龄、胸外科医师学会/欧洲心胸外科学会（STAT）评分、体外循环时间）进行比较，并与包括脑利钠肽和胱抑素 C 在内的预后生物标志物进行比较。
方法
在术后 12 至 36 小时对 237 名儿童（中位年龄 0.55 岁；四分位距 0.09-4.15 岁）进行 LUS 检查。对于每个半胸廓，在上部和下部评估 3 个区域（前/侧/后），构成 12 个总扫描区域。对于每个部位，分配一个分数：0（罕见 B 线）、1（分离 B 线）、2（融合 B 线）、3（通气丧失），并计算所有部位的总 LUS 评分。主要终点是重症监护病房住院时间和拔管时间。
结果
总 LUS 评分平均为 12.88 ± 6.41（范围，0-26），新生儿（16.77 ± 5.25）高于较大儿童（5.36 ± 5.57；P<.001）。单因素分析显示，LUS 评分与年龄呈负相关（β0.26；P =.004）和体表面积（β3.41 P =.006）呈正相关，与脑利钠肽（β1.65；P <.001）和胱抑素 C（β2.41；P <.001）呈正相关。当将 LUS 评分作为连续预测因子添加到传统风险模型（年龄、STAT 评分和体外循环时间）中时，对于重症监护病房住院时间（β0.145，P =.047）和拔管时间（β1.644；P =.024）均具有显著意义。当分析单个象限时，只有前 LUS 评分具有显著意义（重症监护病房住院时间β，0.471；P =.020；拔管时间β5.530；P =.007）。
结论
我们的数据表明，在儿科心脏手术中，一种新的 LUS 评分比传统危险因素具有更好的预后预测价值。
Zotero 插件