Lee Ji-Hyun, Kang Pyoyoon, Park Jung-Bin, Kim Jin-Tae
From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Eur J Anaesthesiol. 2023 Dec 1;40(12):953-956. doi: 10.1097/EJA.0000000000001910. Epub 2023 Oct 12.
Few studies have investigated the changes in diaphragmatic function and their association with postoperative pulmonary complications (PPCs) in paediatric patients after lung resection.
This study aimed to evaluate diaphragmatic function using ultrasound after lung resection and its influence on PCCs in children.
Prospective observational study.
A tertiary children's hospital.
Children aged 6 years or less who were scheduled for video-assisted thoracoscopic lung resection.
Ultrasonographic measurements of diaphragmatic excursion (DE) and thickening fraction (TF) were performed for three epochs: before anaesthesia induction (T0), 1 h postoperatively (T1) and 24 h postoperatively (T2). The thickening fraction is calculated from the thickness of the diaphragm at end expiration and end inspiration at each time point. DE T1 /DE T0 , DE T2 /DE T0 , TF T1 /TF T0 and TF T2 /TF T0 (%) were calculated. The incidence of PCCs was also determined.
The primary outcomes were changes in diaphragmatic excursion and thickening fraction over time, from T0 to T2. The secondary outcomes were the association between ultrasound parameters of diaphragm function and the occurrence of early PPCs within 3 days.
Data from 74 children were analysed. On the operated side, both diaphragmatic excursion and thickening fraction decreased at T1 and recovered slightly at T2, and were significantly lower than the T0 values. Children with PPCs had significantly lower DE T2 /DE T0 and TF T2 /TF T0 scores on the operated side than those without PPCs. According to the receiver operating characteristic analysis, the DE T2 /DE T0 (< 61.1%) on the operated side was associated with PPCs with an area under the curve of 0.764.
Peri-operative diaphragmatic function assessed by ultrasonography changed after lung resection in children. The diaphragmatic excursion and thickening fraction decreased postoperatively, and a prolonged decrease in diaphragmatic excursion was associated with pulmonary complications after lung surgery in children.
ClinicalTrials.gov, NCT04400370.
很少有研究调查小儿肺切除术后膈肌功能的变化及其与术后肺部并发症（PPCs）的关系。
本研究旨在评估肺切除术后小儿的膈肌功能，并探讨其对小儿PPCs的影响。
前瞻性观察性研究。
一家三级儿童医院。
计划行电视辅助胸腔镜肺切除术的6岁及以下儿童。
在三个时间点进行超声测量膈肌移动度（DE）和增厚率（TF）：麻醉诱导前（T0）、术后1小时（T1）和术后24小时（T2）。增厚率是根据每个时间点呼气末和吸气末膈肌的厚度计算得出的。计算DE T1 /DE T0 、DE T2 /DE T0 、TF T1 /TF T0 和TF T2 /TF T0 （%）。同时确定PPCs的发生率。
主要观察指标是从T0到T2膈肌移动度和增厚率随时间的变化。次要观察指标是膈肌功能超声参数与术后3天内早期PPCs发生之间的关联。
分析了74例儿童的数据。在手术侧，T1时膈肌移动度和增厚率均降低，T2时略有恢复，但均显著低于T0值。发生PPCs的儿童手术侧的DE T2 /DE T0 和TF T2 /TF T0 评分显著低于未发生PPCs的儿童。根据受试者工作特征分析，手术侧的DE T2 /DE T0 （<61.1%）与PPCs相关，曲线下面积为0.764。
小儿肺切除术后，超声评估的围手术期膈肌功能发生了变化。术后膈肌移动度和增厚率降低，膈肌移动度的持续降低与小儿肺切除术后的肺部并发症相关。
ClinicalTrials.gov，NCT04400370。
