小儿左心室流出道梗阻患者围手术期危险因素评估
Evaluation of perioperative risk factors in pediatric patients with left ventricle outflow tract obstruction.
作者信息
Önemli Canan Salman, Şahin Kübra Evren, Karaçelik Mustafa, Bilen Çagatay
机构信息
Department of Anesthesiology and Reanimation, Saglik Bilimleri University, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey.
Department of Pediatric Cardiovascular Surgery, Saglik Bilimleri University, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey.
出版信息
Kardiochir Torakochirurgia Pol. 2023 Dec;20(4):220-227. doi: 10.5114/kitp.2023.134161. Epub 2024 Jan 11.
INTRODUCTION
Left ventricular outflow tract obstructions (LVOTO) presents as complex cardiac diseases accompanied by other cardiac anomalies in the pediatric age group. Postoperative complications, especially cardiac, pulmonary, and renal complications, that may develop after pediatric cardiac surgery can become life-threatening. If the perioperative risk factors for these complications are known in pediatric patients with LVOTO, anesthesiologists and surgeons may take precautions to eliminate undesirable outcomes.
AIM
To evaluate the perioperative risk factors that may contribute to the development of postoperative complications in pediatric patients operated on for LVOTO in a pediatric cardiac surgery clinic.
MATERIAL AND METHODS
The study retrospectively investigated 58 patients who were operated on for LVOTO in a pediatric cardiac surgery clinic. The patients were divided into two groups, those with and without postoperative complications. Preoperative laboratory test results, anesthesia time, operation time, aortic cross-clamp time, cardiopulmonary bypass (CPB) time, postoperative inotropes, first postoperative laboratory tests, intraoperative and postoperative complications, mechanical ventilation time, intensive care unit stay, and hospital stay were recorded.
RESULTS
The most common postoperative complications were endocrine complications, followed by hepatic complications. The preoperative lymphocyte count was significantly higher ( < 0.05), and the neutrophil-to-lymphocyte ratio (NLR) was significantly lower ( < 0.05) in the group with postoperative complications. The postoperative pH, glucose, creatinine, and aspartate aminotransferase (AST) levels were significantly lower ( < 0.05), and the postoperative calcium level was significantly higher ( < 0.05) in the group without postoperative complications. Intraoperative platelet transfusion rate was found to be significantly lower ( < 0.05) in the group with postoperative complications.
CONCLUSIONS
It is critical to identify predictive factors to prevent postoperative complications in pediatric patients undergoing surgery for LVOTO. Preoperative NLR, intraoperative platelet transfusion, and postoperative calcium, glucose, pH and AST levels may help in the prediction of complications.
引言
左心室流出道梗阻（LVOTO）在儿童年龄组中表现为复杂的心脏疾病，并伴有其他心脏异常。小儿心脏手术后可能出现的术后并发症，尤其是心脏、肺部和肾脏并发症，可能会危及生命。如果已知患有LVOTO的小儿患者这些并发症的围手术期危险因素，麻醉医生和外科医生可以采取预防措施以避免不良后果。
目的
评估在小儿心脏外科诊所接受LVOTO手术的小儿患者术后并发症发生的围手术期危险因素。
材料与方法
该研究回顾性调查了在小儿心脏外科诊所接受LVOTO手术的58例患者。患者分为两组，有术后并发症组和无术后并发症组。记录术前实验室检查结果、麻醉时间、手术时间、主动脉阻断时间、体外循环（CPB）时间、术后使用的正性肌力药物、术后首次实验室检查结果、术中和术后并发症、机械通气时间、重症监护病房停留时间和住院时间。
结果
最常见的术后并发症是内分泌并发症，其次是肝脏并发症。术后并发症组术前淋巴细胞计数显著更高（<0.05），中性粒细胞与淋巴细胞比值（NLR）显著更低（<0.05）。无术后并发症组术后pH值、血糖、肌酐和天冬氨酸转氨酶（AST）水平显著更低（<0.05），术后钙水平显著更高（<0.05）。发现术后并发症组术中血小板输注率显著更低（<0.05）。
结论
识别接受LVOTO手术的小儿患者术后并发症的预测因素至关重要。术前NLR、术中血小板输注以及术后钙、血糖、pH值和AST水平可能有助于预测并发症。
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