在儿科患者中，完全手术修复肺动脉闭锁伴室间隔缺损和肺血管发育不良后，早期拔管与改善结局相关。
Early extubation is associated with improved outcomes after complete surgical repair of pulmonary atresia with ventricular septal defect and hypoplastic pulmonary arteries in pediatric patients.
机构信息
Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
出版信息
J Cardiothorac Surg. 2021 Mar 19;16(1):31. doi: 10.1186/s13019-021-01416-y.
BACKGROUND
The aim of this study was to investigate the impact of an early extubation strategy on outcomes following complete repair of pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary artery.
METHODS
One hundred thirteen patients undergoing complete repair surgery of pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary artery between 2016 and 2018 were included in our retrospective propensity-score matched study. Propensity score matching was conducted in 1 to 2 ratio to balance the covariables impacting on clinical outcomes between groups. The primary outcomes were defined as length of intensive care unit stay, postoperative length of hospital stay and in-hospital medical cost. The secondary outcomes included postoperative complications such as re-intubation, re-exploration, in-hospital mortality, arrhythmia and etc.. In addition, blood product consumption were also abstracted.
RESULTS
Compared with matched controls, patients in the early extubation group were demonstrated with a significant reduced length of intensive care unit stay (Median: 1.9 d νs. 4.1 d, p = 0.039), postoperative length of hospital stay (Median: 9.0 d νs. 17.0 d, p = 0.007) and in-hospital medical cost (Median: 69.5 × 1000CNY νs. 113.6× 1000CNY, p = 0.041). As for the postoperative complications, the occurrence of re-intubation, re-exploration, in-hospital mortality, arrhythmia and renal replacement therapy was similar between groups. However, pulmonary complications (p = 0.049) were with a significantly lower rate in the early extubation group. In addition, fresh frozen plasma (p = 0.041) transfusion volume were significantly reduced in the early extubation group rather than packed red blood cells and platelets.
CONCLUSIONS
Early extubation following complete repair of pulmonary atresia improved clinical outcomes and reduced in-hospital medical cost without increasing any postoperative complications.
背景
本研究旨在探讨早期拔管策略对完全修复肺动脉闭锁、室间隔缺损和肺动脉发育不良后结局的影响。
方法
回顾性分析 2016 年至 2018 年期间 113 例行完全修复手术的肺动脉闭锁、室间隔缺损和肺动脉发育不良患者的资料。采用 1:2 的倾向评分匹配平衡组间影响临床结局的协变量。主要结局为重症监护病房住院时间、术后住院时间和院内医疗费用。次要结局包括术后并发症，如再次插管、再次探查、院内死亡率、心律失常等。此外，还摘录了血液制品的使用情况。
结果
与匹配对照组相比，早期拔管组的重症监护病房住院时间（中位数：1.9 d νs. 4.1 d，p=0.039）、术后住院时间（中位数：9.0 d νs. 17.0 d，p=0.007）和院内医疗费用（中位数：69.5×1000 CNY νs. 113.6×1000 CNY，p=0.041）明显降低。术后并发症的发生率，如再次插管、再次探查、院内死亡率、心律失常和肾脏替代治疗，两组间无差异。然而，早期拔管组的肺部并发症发生率（p=0.049）明显较低。此外，早期拔管组的新鲜冰冻血浆（p=0.041）输注量明显低于红细胞和血小板。
结论
肺动脉闭锁完全修复后早期拔管可改善临床结局，降低院内医疗费用，且不增加术后并发症。
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