与早发性脊柱侧凸患儿后路脊柱内固定术后呼吸系统并发症相关的因素。
Factors Associated with Postoperative Respiratory Complications following Posterior Spinal Instrumentation in Children with Early-onset Scoliosis.
机构信息
Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China.
出版信息
Orthop Surg. 2022 Jul;14(7):1489-1497. doi: 10.1111/os.13351. Epub 2022 Jun 10.
OBJECTIVE
To investigate the incidence and risk factors of postoperative respiratory complications (PRCs) in children with early-onset scoliosis (EOS) following posterior spine deformity surgery (PSDS) based on growth-friendly techniques, so as to help improve the safety of surgery.
METHODS
A retrospective study of children with EOS admitted for PSDS based on growth-friendly techniques from October 2013 to October 2018 was reviewed at a single center. There were 73 children (30 boys, 43 girls) who fulfilled the criteria in this research. The mean age of the patients was 7 ± 6.2 years. Patients were divided into the groups with and without PRCs. Variables that might affect the PRCs during the perioperative period, including general factors, radiographic factors, laboratory factors and surgical factors, were analyzed using univariate analysis to evaluate the potential risk factors. The variables that were significantly different were further analyzed by binary logistic regression analysis to identify the independent factors of PRCs.
RESULTS
All the 73 children included 42 idiopathic scoliosis (57.5%), 12 congenital scoliosis (16.4%), 10 syndromic scoliosis (13.7%) and nine neuromuscular scoliosis (12.3%). PRCs were detected in 16 children (21.9%) with nine different PRCs. The total frequency of detected PRCs was 54, including pleural effusion (25.9%), postoperative pneumonia (20.4%), hypoxemia (18.5%), atelectasis (14.8%), prolonged intubation with mechanical positive pressure ventilatory support (PIMPPVS) (7.4%), bronchospasm (3.7%), reintubation (3.7%), delayed extubation (3.7%) and pneumothorax (1.9%). Results of univariate testing demonstrated that the following six variables were statistically different (P < 0.05): nonidiopathic scoliosis, combined with pulmonary comorbidities, pretransferrin < 200 mg/dL, prealbumin < 3.5 g/dL, anesthesia time ≥ 300 min and blood loss to total blood volume ratio (BL/TBV) ≥ 15%. Binary logistic regression analysis confirmed that BL/TBV≥15% (odd ratio OR = 29.188, P = 0.010), combined with pulmonary comorbidities (OR = 19.216, P = 0.012), pretransferrin < 200 mg/dL (OR = 11.503, p = 0.024), and nonidiopathic scoliosis (OR = 7.632, P = 0.046) were positively linear correlated with PRCs in children with EOS following PSDS.
CONCLUSION
PRCs has a higher incidence in children with EOS following PSDS. BL/TBV ≥15%, combined with pulmonary comorbidities, pre-transferrin < 200 mg/dL, and nonidiopathic scoliosis play an important role for the development of PRCs in this population.
目的
基于生长友好型技术，探讨儿童早发性脊柱侧凸（EOS）后路脊柱畸形矫正术后（PSDS）发生术后呼吸系统并发症（PRCs）的发生率和危险因素，以帮助提高手术安全性。
方法
回顾性分析了 2013 年 10 月至 2018 年 10 月在我院行 PSDS 基于生长友好型技术的 EOS 患儿的病例资料。共纳入符合研究标准的患儿 73 例（男 30 例，女 43 例）。患儿平均年龄为 7 ± 6.2 岁。根据是否发生 PRCs 将患儿分为 PRCs 组和非 PRCs 组。采用单因素分析评估围手术期可能影响 PRCs 的一般因素、影像学因素、实验室因素和手术因素等变量，评估潜在的危险因素。对差异有统计学意义的变量进一步采用二元 logistic 回归分析，确定 PRCs 的独立危险因素。
结果
73 例患儿中，特发性脊柱侧凸 42 例（57.5%），先天性脊柱侧凸 12 例（16.4%），综合征型脊柱侧凸 10 例（13.7%），神经肌肉型脊柱侧凸 9 例（12.3%）。16 例（21.9%）患儿发生了 9 种不同的 PRCs，总检出率为 54 例次，包括胸腔积液 25.9%，术后肺炎 20.4%，低氧血症 18.5%，肺不张 14.8%，带机械正压通气支持的长时间（≥300 min）气管插管 7.4%，支气管痉挛 3.7%，再次插管 3.7%，延迟拔管 3.7%，气胸 1.9%。单因素检验结果表明，以下 6 个变量差异有统计学意义（P<0.05）：非特发性脊柱侧凸、合并肺部合并症、转铁蛋白前体（pre-transferrin）<200 mg/dL、前白蛋白（prealbumin）<3.5 g/dL、麻醉时间≥300 min、血容量比（blood loss to total blood volume ratio，BL/TBV）≥15%。二元 logistic 回归分析证实，BL/TBV≥15%（比值比 OR=29.188，P=0.010）、合并肺部合并症（OR=19.216，P=0.012）、pre-transferrin<200 mg/dL（OR=11.503，P=0.024）、非特发性脊柱侧凸（OR=7.632，P=0.046）与 EOS 患儿 PSDS 后 PRCs 呈正相关。
结论
EOS 患儿 PSDS 后 PRCs 的发生率较高。BL/TBV≥15%、合并肺部合并症、pre-transferrin<200 mg/dL 和非特发性脊柱侧凸是该人群 PRCs 发生的重要因素。
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