Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Pediatric Surgery, University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
Eur J Pediatr Surg. 2020 Dec;30(6):497-504. doi: 10.1055/s-0039-3401987. Epub 2020 Jan 20.
Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal condition that can lead to metabolic alkalosis and, if uncorrected, to respiratory complications. A standardized approach to correct metabolic derangements and dehydration may reduce time until pyloromyotomy while preventing potential respiratory complications. Such an evidence-based policy regarding preoperative care is absent. We aim to formulate a recommendation about preoperative care for infants with IHPS using the Delphi technique.
The RAND/UCLA appropriateness method was used to reach international consensus in a panel of pediatric surgeons, pediatric anesthetists, and pediatricians. Statements on type and frequency of blood sampling, required serum concentrations before pyloromyotomy and intravenous fluid therapy, were rated online using a 9-point Likert scale. Consensus was present if the panel rated the statement appropriate/obligatory (panel median: 7-9) or inappropriate/unnecessary (panel median: 1-3) without disagreement according to the interpercentile range adjusted for symmetry formula.
Thirty-three and twenty-nine panel members completed the first and second round, respectively. Consensus was reached in 54/74 statements (73%). The panel recommended the following laboratory tests and corresponding cutoff values prior to pyloromyotomy: pH ≤7.45, base excess ≤3.5, bicarbonate <26 mmol/L, sodium ≥132 mmol/L, potassium ≥3.5 mmol/L, chloride ≥100 mmol/L, and glucose ≥4.0 mmol/L. Isotonic crystalloid with 5% dextrose and 10 to 20 mEq/L potassium should be used for fluid resuscitation.
Consensus is reached in an expert panel about assessment of metabolic derangements at admission, cutoff serum concentrations to be achieved prior to pyloromyotomy, and appropriate intravenous fluid regime for the correction of dehydration and metabolic derangements in infants with IHPS.
婴儿肥厚性幽门狭窄（IHPS）是一种常见的胃肠道疾病，可导致代谢性碱中毒，如果不纠正，可导致呼吸并发症。标准化的方法来纠正代谢紊乱和脱水可能会减少幽门肌切开术的时间，同时预防潜在的呼吸并发症。对于术前护理，目前还没有这样的循证政策。我们旨在使用德尔菲技术为 IHPS 婴儿制定术前护理建议。
使用 RAND/UCLA 适宜性方法在一组儿科外科医生、儿科麻醉师和儿科医生小组中达成国际共识。关于血液采样的类型和频率、幽门肌切开术前所需的血清浓度以及静脉输液治疗的陈述，通过 9 分李克特量表在线进行评分。如果小组根据对称性公式调整的百分位范围对该陈述进行了适当/必需（小组中位数：7-9）或不适当/不必要（小组中位数：1-3）的评分，且没有分歧，则表示达成共识。
33 名和 29 名小组成员分别完成了第一轮和第二轮投票。在 74 项声明中有 54 项（73%）达成共识。小组建议在进行幽门肌切开术前进行以下实验室检查和相应的截止值：pH 值≤7.45、碱剩余≤3.5、碳酸氢盐<26mmol/L、钠≥132mmol/L、钾≥3.5mmol/L、氯≥100mmol/L 和葡萄糖≥4.0mmol/L。应使用等渗晶体液加 5%葡萄糖和 10 至 20mEq/L 钾进行液体复苏。
在一个专家小组中就入院时代谢紊乱的评估、幽门肌切开术前要达到的血清浓度截止值以及 IHPS 婴儿脱水和代谢紊乱纠正的适当静脉输液方案达成了共识。
