Wu Xie, An Ran, Luo Qipeng, Li Yinan, Wang Hongbai, Liu Qiao, Huang Jiangshan, Jia Yuan, Yuan Su, Yan Fuxia
Department of Anesthesiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Aug 22;9:967240. doi: 10.3389/fcvm.2022.967240. eCollection 2022.
As an easily accessible and intervened clinical indicator, preoperative pulse oximeter oxygen saturation (SpO) is an important factor affecting the prognosis of patients with tetralogy of Fallot (TOF). However, whether SpO is associated with postoperative mechanical ventilation (MV) time remains unknown. Therefore, this study aimed to investigate the impact of preoperative SpO on postoperative prolonged mechanical ventilation (PMV) in children with TOF.
The study included children younger than 18 years who underwent corrective operations for TOF between January 2016 and December 2018 in Fuwai Hospital, China. Univariate and multivariate logistic regression analyses were used to evaluate the influence of preoperative SpO on postoperative PMV. After identifying SpO as an independent risk factor for PMV, patients were further divided into two groups according to the cutoff value of SpO, and propensity score matching (PSM) analysis was used to eliminate the effect of confounding factors. The logistic regression was used to compare the outcomes between the two groups after PSM.
A total of 617 patients were finally enrolled in this study. By the univariable and multivariate logistic analysis, four independent risk factors for PMV were determined, namely, SpO, surgical technique, aortic cross-clamp time, and intraoperative minimum temperature. According to the outcomes of 219 paired patients after PSM, the incidence of PMV was significantly higher in patients with lower preoperative SpO ( = 0.022). Also, there was significant increase in mechanical ventilation time ( = 0.019), length of intensive care unit stay ( = 0.044), postoperative hospital stay ( = 0.006), hospital stay ( = 0.039), and hospitalization cost ( = 0.019) at the lower preoperative SpO level.
Low preoperative SpO represents an independent risk factor of postoperative PMV in children with TOF.
作为一种易于获取且可干预的临床指标，术前脉搏血氧饱和度（SpO）是影响法洛四联症（TOF）患者预后的重要因素。然而，SpO是否与术后机械通气（MV）时间相关仍不清楚。因此，本研究旨在探讨术前SpO对TOF患儿术后长时间机械通气（PMV）的影响。
本研究纳入了2016年1月至2018年12月在中国阜外医院接受TOF矫治手术的18岁以下儿童。采用单因素和多因素logistic回归分析来评估术前SpO对术后PMV的影响。在确定SpO为PMV的独立危险因素后，根据SpO的截断值将患者进一步分为两组，并采用倾向评分匹配（PSM）分析来消除混杂因素的影响。PSM后，使用logistic回归比较两组的结果。
本研究最终共纳入617例患者。通过单因素和多因素logistic分析，确定了PMV的四个独立危险因素，即SpO、手术技术、主动脉阻断时间和术中最低体温。根据PSM后219对配对患者的结果，术前SpO较低的患者PMV发生率显著更高（P = 0.022）。此外，术前SpO较低水平时，机械通气时间（P = 0.019）、重症监护病房住院时间（P = 0.044）、术后住院时间（P = 0.006）、住院时间（P = 0.039）和住院费用（P = 0.019）均显著增加。
术前SpO较低是TOF患儿术后PMV的独立危险因素。
