Haga Taiki, Akamine Yoko, Yamamoto Hiroshi, Kazuta Takao, Oba Hikoaki, Iwata Hirofumi, Otsuka Yasunori, Ujiro Atsushi
Department of Pediatric Critical Care Medicine, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima, Osaka, 534-0021, Japan.
Pediatr Cardiol. 2020 Feb;41(2):366-371. doi: 10.1007/s00246-019-02268-z. Epub 2019 Dec 13.
The indications for using temporary epicardial pacing wires after pediatric cardiac surgery remain unclear. Post-procedure intracardiac pressure is valuable for detecting circulatory disturbances and residual lesions. This study aimed to examine the association between post-procedure intracardiac pressures and the use of temporary epicardial pacing wires. We performed a retrospective, case-control study at the pediatric intensive care unit of an urban regional tertiary hospital that included patients who had undergone congenital heart surgery between January 2015 and December 2016. We measured post-procedure intracardiac pressures, and data regarding baseline characteristics, procedures performed, and intraoperative variables were collected as covariates. Of the 186 included patients, 34 (18.3%) were treated using temporary epicardial pacing wires. The optimal cutoff values used to predict the use of pacing wires for central venous pressure, left atrial pressure, pulmonary arterial pressure/systemic blood pressure ratio, and right ventricular pressure/left ventricular pressure ratio were 11 mmHg (55.6% sensitivity, 86.2% specificity), 13 mmHg (50% sensitivity, 84.6% specificity), 0.39 (69.6% sensitivity, 78.7% specificity), and 0.51 (74.1% sensitivity, 64.2% specificity), respectively. Multivariable logistic regression analyses showed that the use of temporary epicardial pacing wires was significantly associated with left atrial pressure ≥ 11 mmHg (odds ratio 4.4; 95% confidence interval 1.01-18.9), and a pulmonary arterial pressure/systemic blood pressure ratio ≥ 0.39 (odds ratio 6.3; 95% confidence interval 1.3-31.4). High post-procedure intracardiac pressures were associated with the use of temporary epicardial pacing wires. These data can aid in the decision-making for the proper use of temporary epicardial pacing wires.
小儿心脏手术后使用临时心外膜起搏导线的指征仍不明确。术后心内压对于检测循环系统紊乱和残余病变很有价值。本研究旨在探讨术后心内压与临时心外膜起搏导线使用之间的关联。我们在一家城市地区三级医院的儿科重症监护病房进行了一项回顾性病例对照研究，纳入了2015年1月至2016年12月期间接受先天性心脏病手术的患者。我们测量了术后心内压，并收集了有关基线特征、所施行的手术以及术中变量的数据作为协变量。在纳入的186例患者中，34例（18.3%）使用了临时心外膜起搏导线。用于预测起搏导线使用的中心静脉压、左心房压、肺动脉压/体循环血压比值以及右心室压/左心室压比值的最佳截断值分别为11 mmHg（灵敏度55.6%，特异度86.2%）、13 mmHg（灵敏度50%，特异度84.6%）、0.39（灵敏度69.6%，特异度78.7%）和0.51（灵敏度74.1%，特异度64.2%）。多变量逻辑回归分析显示，使用临时心外膜起搏导线与左心房压≥11 mmHg（比值比4.4；95%置信区间1.01 - 18.9）以及肺动脉压/体循环血压比值≥0.39（比值比6.3；95%置信区间1.3 - 31.4）显著相关。术后高心内压与临时心外膜起搏导线的使用有关。这些数据有助于指导临时心外膜起搏导线的合理使用决策。
