Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado.
Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Ann Thorac Surg. 2021 Feb;111(2):655-661. doi: 10.1016/j.athoracsur.2020.04.028. Epub 2020 May 27.
Fluid overload contributes to poor outcomes after neonatal cardiac surgery. The optimal strategy to mitigate fluid overload related morbidity is unknown. The utility of prophylactic peritoneal dialysis remains controversial. We aimed to assess the impact of prophylactic peritoneal dialysis on outcomes and hypothesized that prophylactic dialysis would be associated with less fluid overload and improved outcomes in neonates undergoing the arterial switch operation.
A single-center retrospective analysis of 41 consecutive neonates between June 2010 and March 2016 undergoing the arterial switch operation was performed. Fluid balance and other outcomes were compared between those who received peritoneal dialysis (n = 25) and those who did not (n = 16).
Demographics were similar between groups, except cardiopulmonary bypass duration, which was significantly longer in the dialysis group (125 ± 20 minutes) compared with the no dialysis group (109 ± 15 minutes; P = .01). Median time to dialysis initiation was 9.1 hours (interquartile range, 7 to 9.8) and median time to termination from cardiac intensive care unit admission was 58.7 hours (interquartile range, 44 to 76.1). Cumulative fluid balance in the dialysis group was significantly more negative compared with the no dialysis group across all 7 postoperative days. In the multivariable analysis, use of dialysis was associated with a 42% reduction in hours of mechanical ventilation (relative risk 0.58; 95% confidence interval, 0.4 to 0.85; P < .01) and a 34% reduction in intensive care unit length of stay (relative risk 0.66; 95% confidence interval, 0.47 to 0.94; P = .02). Utilization of dialysis was associated with lower hospital costs (P < .01).
Prophylactic peritoneal dialysis after the arterial switch operation is associated with improved postoperative outcomes without increased hospital costs (Graphical Abstract).
液体超负荷是新生儿心脏手术后不良预后的原因之一。减轻与液体超负荷相关的发病率的最佳策略尚不清楚。预防性腹膜透析的效果仍存在争议。我们旨在评估预防性腹膜透析对结果的影响，并假设在接受大动脉调转术的新生儿中，预防性透析将与更少的液体超负荷和更好的结局相关。
对 2010 年 6 月至 2016 年 3 月间在我院接受大动脉调转术的 41 例连续新生儿进行了单中心回顾性分析。比较了接受腹膜透析（n=25）和未接受腹膜透析（n=16）患儿的液体平衡和其他结局。
两组患者的一般资料相似，但透析组体外循环时间明显较长（125±20 分钟），而无透析组为 109±15 分钟（P=0.01）。开始透析的中位时间为 9.1 小时（四分位间距 7 至 9.8），从心脏重症监护病房入院到结束透析的中位时间为 58.7 小时（四分位间距 44 至 76.1）。在术后 7 天内，透析组的累积液体平衡明显较无透析组为负。在多变量分析中，使用透析与机械通气时间减少 42%相关（相对风险 0.58；95%置信区间 0.4 至 0.85；P<0.01），与 ICU 住院时间减少 34%相关（相对风险 0.66；95%置信区间 0.47 至 0.94；P=0.02）。使用透析与较低的住院费用相关（P<0.01）。
大动脉调转术后预防性腹膜透析可改善术后结局，而不增加住院费用（图摘要）。
