van den Bunder Fenne A I M, van Wijk Lotte, van Woensel Job B M, Stevens Markus F, van Heurn L W Ernest, Derikx Joep P M
Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
Department of Paediatric Intensive Care, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Paediatr Anaesth. 2020 Jul;30(7):749-758. doi: 10.1111/pan.13879. Epub 2020 Jun 18.
Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed that metabolic derangements should be corrected prior to surgery to prevent apnea, the exact incidence of perioperative apneas in infants with IHPS and the association with metabolic alkalosis are unknown. We performed this systematic review to assess the incidence of apnea in infants with IHPS and to verify the possible association between apnea and metabolic alkalosis.
We searched MEDLINE, Embase, and Cochrane library to identify studies regarding infants with metabolic alkalosis, respiratory problems, and hypertrophic pyloric stenosis. We conducted a descriptive synthesis of the findings of the included studies.
Thirteen studies were included for analysis. Six studies described preoperative apnea, three studies described postoperative apnea, and four studies described both. All studies were of low quality or had other research questions. We found an incidence of 27% of preoperative and 0.2%-16% of postoperative apnea, respectively. None of the studies examined the association between apnea and metabolic alkalosis in infants with IHPS.
Infants with IHPS may have a risk to develop perioperative apnea. However, the incidence rates should be interpreted with caution because of the low quality and quantity of the studies. Therefore, further studies are required to determine the incidence of perioperative apnea in infants with IHPS. The precise underlying mechanism of apnea in these infants is still unknown, and the role of metabolic alkalosis should be further evaluated.
婴儿肥厚性幽门狭窄（IHPS）会导致反复呕吐和代谢性碱中毒，进而可能引发呼吸暂停。尽管一般认为在手术前应纠正代谢紊乱以预防呼吸暂停，但IHPS婴儿围手术期呼吸暂停的确切发生率以及与代谢性碱中毒的关联尚不清楚。我们进行了这项系统评价，以评估IHPS婴儿呼吸暂停的发生率，并验证呼吸暂停与代谢性碱中毒之间可能存在的关联。
我们检索了MEDLINE、Embase和Cochrane图书馆，以确定有关患有代谢性碱中毒、呼吸问题和肥厚性幽门狭窄婴儿的研究。我们对纳入研究的结果进行了描述性综合分析。
纳入13项研究进行分析。6项研究描述了术前呼吸暂停，3项研究描述了术后呼吸暂停，4项研究两者均有描述。所有研究质量都很低或有其他研究问题。我们分别发现术前呼吸暂停的发生率为27%，术后呼吸暂停的发生率为0.2%-16%。没有一项研究探讨IHPS婴儿呼吸暂停与代谢性碱中毒之间的关联。
IHPS婴儿可能有发生围手术期呼吸暂停的风险。然而，由于研究的质量和数量较低，对发生率应谨慎解读。因此，需要进一步研究以确定IHPS婴儿围手术期呼吸暂停的发生率。这些婴儿呼吸暂停的确切潜在机制仍然未知，代谢性碱中毒的作用应进一步评估。
