脑瘫青少年脊柱侧弯手术后全身炎症反应综合征的预测因素：一项回顾性分析。
Predictors of postoperative systemic inflammatory response syndrome after scoliosis surgery in adolescents with cerebral palsy: A retrospective analysis.
作者信息
Sadacharam Kesavan, He Zhaoping, Edelson Maureen F, McMahon Kimberly, Madurski Catherine, Brenn B Randall
机构信息
Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
出版信息
N Am Spine Soc J. 2022 Jun 11;11:100135. doi: 10.1016/j.xnsj.2022.100135. eCollection 2022 Sep.
BACKGROUND
Systemic inflammatory response syndrome (SIRS) is known to complicate postsurgical intensive care patients. We noticed that roughly half children with cerebral palsy who undergo posterior spinal fusion (PSF) for neuromuscular scoliosis developed SIRS in the intensive care unit. There is a paucity of literature detailing the impact of intraoperative causes of postoperative SIRS and downstream consequences in these patients. Study purpose was to understand the factors associated with SIRS in children who undergo PSF for neuromuscular scoliosis.
METHODS
This retrospective, case control study included children who underwent PSF for neuromuscular scoliosis. Patients with idiopathic scoliosis, osteogenesis imperfecta, and tracheotomy were excluded. Subjects were divided into two study groups based on the diagnosis of SIRS in the intensive care unit. Descriptive statistical analysis was used to identify factors associated with SIRS; a regression analysis was used to further evaluate the independent and significant influence of these factors.
RESULTS
There was no significant difference in the demographic and other preoperative variables. However, total blood products (ml/kg) administered was significantly higher among the SIRS group compared with the non-SIRS group (54.4±41.0 vs 34.1±21.5 <0.034). Percent of patients remaining intubated was greater in the SIRS group compared with the non-SIRS group (44.1% vs 7.0%, < 0.001). The regression model revealed that the odds to develop SIRS in patients who were not extubated were 7.467-fold higher (CI: 1.534-36.347) compared with those who were extubated (=0.013).
CONCLUSIONS
The incidence of SIRS is significantly higher among the patients who were not extubated at the end of PSF surgery. Further prospective studies are needed to look at the factors that impede the ability to extubate these patients at the end of surgery.
背景
全身炎症反应综合征（SIRS）是术后重症监护患者常见的并发症。我们注意到，大约一半因神经肌肉性脊柱侧弯接受后路脊柱融合术（PSF）的脑瘫患儿在重症监护病房发生了SIRS。目前关于术后SIRS的术中原因及其对这些患者的下游影响的文献较少。本研究的目的是了解因神经肌肉性脊柱侧弯接受PSF手术的儿童发生SIRS的相关因素。
方法
本回顾性病例对照研究纳入了因神经肌肉性脊柱侧弯接受PSF手术的儿童。排除特发性脊柱侧弯、成骨不全和气管切开术患者。根据重症监护病房中SIRS的诊断将受试者分为两个研究组。采用描述性统计分析来确定与SIRS相关的因素；采用回归分析进一步评估这些因素的独立和显著影响。
结果
两组患者的人口统计学和其他术前变量无显著差异。然而，SIRS组输注的全血制品总量（ml/kg）显著高于非SIRS组（54.4±41.0 vs 34.1±21.5，<0.034）。SIRS组患者术后仍需插管的比例高于非SIRS组（44.1% vs 7.0%，<0.001）。回归模型显示，未拔管患者发生SIRS的几率比拔管患者高7.467倍（CI：1.534 - 36.347）（P = 0.013）。
结论
PSF手术结束时未拔管的患者中SIRS的发生率显著更高。需要进一步的前瞻性研究来探讨阻碍这些患者在手术结束时拔管的因素。
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