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.
BMC Anesthesiol. 2023 Oct 17;23(1):346. doi: 10.1186/s12871-023-02290-y.
Tetralogy of Fallot (TOF) is a common cyanotic congenital heart malformation that carries a high risk of right-to-left shunting. Anemia is characterized by decreased hemoglobin (Hb) levels that can affect tissue oxygen delivery and impact postoperative recovery in patients. Chronic hypoxia caused by right-to-left shunting of TOF could lead to compensatory increases in Hb to maintain systemic oxygen balance. This study aims to investigate whether preoperative Hb and blood oxygen saturation (SpO2) can predict adverse outcomes in children undergoing corrective surgery for TOF.
This retrospective study included patients under 18 years of age who underwent corrective surgery for TOF at Fuwai Hospital between January 2016 and December 2018. Adverse outcomes, including in-hospital death, extracorporeal membrane oxygenation implantation, ICU stay > 30 days, and severe complications, were considered as the primary outcome. Univariable and multivariable logistic analyses were performed to identify independent risk factors for adverse outcomes. Propensity score-matched (PSM) analysis was also conducted to minimize the confounding factors.
A total of 596 children were included in the study, of which 64 (10.7%) experienced adverse outcomes. HbSpO2 < aaHb was identified as an independent risk factor for adverse outcomes (OR = 2.241, 95% CI = 1.276-3.934, P = 0.005) after univariable and multivariable logistic analyses. PSM analysis further confirmed the association between HbSpO2 < aaHb and adverse outcomes. Patients with Hb*SpO2 < aaHb had a significantly higher incidence of postoperative adverse outcomes, longer time of mechanical ventilation, and hospital stay, as well as higher in-hospital costs.
Hb*SpO2 < aaHb is significantly associated with adverse outcomes in children undergoing corrective surgery for TOF. Clinicians can use this parameter to early identify high-risk children and optimize their postoperative management.
法洛四联症（TOF）是一种常见的发绀型先天性心脏病，存在很高的右向左分流风险。贫血的特征是血红蛋白（Hb）水平降低，这可能会影响组织氧输送，并影响患者术后的恢复。TOF 引起的右向左分流导致的慢性缺氧可能导致 Hb 代偿性增加，以维持全身氧平衡。本研究旨在探讨术前 Hb 和血氧饱和度（SpO2）是否可以预测 TOF 患儿接受矫正手术后的不良结局。
本回顾性研究纳入了 2016 年 1 月至 2018 年 12 月期间在阜外医院接受 TOF 矫正手术的 18 岁以下患者。主要结局为院内死亡、体外膜肺氧合（ECMO）植入、入住重症监护病房（ICU）超过 30 天和严重并发症。进行单变量和多变量逻辑分析以确定不良结局的独立危险因素。还进行了倾向评分匹配（PSM）分析以最小化混杂因素的影响。
共纳入 596 名儿童，其中 64 名（10.7%）发生不良结局。单变量和多变量逻辑分析均发现 HbSpO2＜aaHb 是不良结局的独立危险因素（OR=2.241，95%CI=1.276-3.934，P=0.005）。PSM 分析进一步证实了 HbSpO2＜aaHb 与不良结局之间的关联。Hb*SpO2＜aaHb 的患者术后不良结局发生率显著较高，机械通气时间、住院时间以及住院费用均显著较高。
Hb*SpO2＜aaHb 与 TOF 患儿矫正手术后的不良结局显著相关。临床医生可以使用该参数来早期识别高危患儿并优化其术后管理。
