Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, The Netherlands.
Paediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, The Netherlands.
J Pediatr Surg. 2020 Dec;55(12):2772-2776. doi: 10.1016/j.jpedsurg.2020.05.041. Epub 2020 Jun 6.
Uncorrected metabolic alkalosis in infantile hypertrophic pyloric stenosis (IHPS) could lead to perioperative apnea. However, the precise incidence of preoperative respiratory problems and the association with metabolic alkalosis are unknown. Therefore, we aimed to determine the incidence of preoperative respiratory problems in IHPS and to assess the association with metabolic alkalosis.
We retrospectively reviewed all patients diagnosed with IHPS during 2007-2017. Respiratory problems were classified as present or absent. With multivariate logistic regression we analyzed the association between bicarbonate and respiratory problems, corrected for gestational age and birth weight.
We included 459 infants, of whom 23 developed preoperative respiratory problems (5.0%). Infants with preoperative respiratory problems were more often female (43.5% vs. 13.3% p = 0.001) and had significantly higher median serum levels of bicarbonate (32.0 mmol/L vs. 30.0 mmol/L), base excess (6.5 mmol/L vs. 5.3 mmol/L) and pCO2 (6.4 kPa vs. 5.9 kPa), compared to infants without respiratory problems. Multivariate analysis of serum bicarbonate and presence of respiratory problems showed an OR of 2.18 per 10 mmol/L (95% CI 1.21-4.71) (p = 0.009). The optimal bicarbonate cutoff point was 25.7 mmol/L (sensitivity 100%, specificity 13.4%).
IHPS with metabolic alkalosis potentially results in preoperative respiratory problems. A lower bicarbonate target before surgery might be recommended and respiratory monitoring should be considered.
Level IV.
婴儿肥厚性幽门狭窄（IHPS）未纠正的代谢性碱中毒可导致围手术期呼吸暂停。然而，术前呼吸问题的确切发生率以及与代谢性碱中毒的关系尚不清楚。因此，我们旨在确定 IHPS 术前呼吸问题的发生率，并评估其与代谢性碱中毒的关系。
我们回顾性分析了 2007 年至 2017 年间所有被诊断为 IHPS 的患者。将呼吸问题分为存在或不存在。我们采用多元逻辑回归分析了碳酸氢盐与呼吸问题之间的关系，并校正了胎龄和出生体重。
共纳入 459 例婴儿，其中 23 例出现术前呼吸问题（5.0%）。有术前呼吸问题的婴儿中，女性的比例（43.5%比 13.3%，p=0.001）更高，血清碳酸氢盐（32.0mmol/L比 30.0mmol/L）、碱剩余（6.5mmol/L比 5.3mmol/L）和 pCO2（6.4kPa 比 5.9kPa）中位数显著更高。与无呼吸问题的婴儿相比。血清碳酸氢盐和呼吸问题存在的多元分析显示，每增加 10mmol/L 的 OR 为 2.18（95%CI 1.21-4.71）（p=0.009）。碳酸氢盐的最佳截断点为 25.7mmol/L（敏感性 100%，特异性 13.4%）。
IHPS 伴代谢性碱中毒可能导致术前呼吸问题。术前可能需要较低的碳酸氢盐目标，应考虑进行呼吸监测。
IV 级。
