Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom; Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom.
Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom.
J Pediatr Surg. 2020 Jul;55(7):1356-1362. doi: 10.1016/j.jpedsurg.2019.11.026. Epub 2020 Jan 26.
Minimally invasive repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) and congenital diaphragmatic hernia (CDH) is feasible and confers benefits compared to thoracotomy or laparotomy. However, carbon dioxide (CO) insufflation can lead to hypercapnia and acidosis. We sought to determine the effect of lower insufflation pressures on patients' surrogate markers for CO absorption - arterial partial pressure of CO (PaCO), end tidal CO (EtCO) and pH.
Single center retrospective review, including neonates without major cardiac anomaly. Selected patients formed 2 groups: Historical pressure (HP) group and low pressure (LP) group. We reported on the patients' preoperative characteristics that potentially confound the degree of CO absorption or elimination. Outcome measures were perioperative PaCO, EtCO, arterial pH and anesthetic time.
30 patients underwent minimally invasive surgery for CDH and 24 patients for EA/TEF with similar distribution within the HP and LP group. For CDH patients as well as for EA/TEF patients, there were no significant differences in their preoperative characteristics or surgery duration comparing HP and LP groups. With a decrease in insufflation pressure in CDH patients, there were a significant decrease (p = 0.002) in peak PaCO and an improvement in nadir pH (p = 0.01). For the EA/TEF patients, the decrease in insufflation pressure was associated with a significant decrease (p = 0.03) in peak EtCO. Considering all 54 patients, we found EtCO to be highly significantly inversely correlated with pH and positively correlated with intraoperative PaCO (p < 0.001). Baseline Hb was inversely correlated with mean EtCO (p < 0.001).
With lower insufflation pressures, CDH patients had significantly improved hypercapnia and acidosis, while EA/TEF patients had significantly reduced EtCO. EtCO was correlated with acidosis and hypercapnia.
Retrospective case control study.
Level III.
与开胸或剖腹手术相比，微创修复食管闭锁伴气管食管瘘（EA/TEF）和先天性膈疝（CDH）具有可行性，并带来益处。然而，二氧化碳（CO）充气会导致高碳酸血症和酸中毒。我们旨在确定较低的充气压力对患者 CO 吸收的替代标志物——动脉血二氧化碳分压（PaCO）、呼气末 CO（EtCO）和 pH 的影响。
单中心回顾性研究，纳入无主要心脏畸形的新生儿。选择的患者分为 2 组：历史压力（HP）组和低压力（LP）组。我们报告了可能影响 CO 吸收或消除程度的患者术前特征。观察指标为围手术期 PaCO、EtCO、动脉 pH 和麻醉时间。
30 例 CDH 患者和 24 例 EA/TEF 患者行微创手术，HP 和 LP 组之间的分布相似。对于 CDH 患者和 EA/TEF 患者，与 HP 组相比，LP 组的患者术前特征和手术持续时间没有显著差异。在 CDH 患者中，随着充气压力的降低，峰值 PaCO 显著降低（p=0.002），最小 pH 值改善（p=0.01）。对于 EA/TEF 患者，充气压力的降低与峰值 EtCO 的显著降低（p=0.03）相关。考虑到所有 54 例患者，我们发现 EtCO 与 pH 值呈高度显著负相关，与术中 PaCO 呈正相关（p<0.001）。基线血红蛋白与平均 EtCO 呈负相关（p<0.001）。
与较高的充气压力相比，CDH 患者的高碳酸血症和酸中毒显著改善，而 EA/TEF 患者的 EtCO 显著降低。EtCO 与酸中毒和高碳酸血症相关。
回顾性病例对照研究。
III 级。
