电视辅助胸腔镜手术患儿机械功率与术后肺部并发症的相关性：一项回顾性研究。

Association of mechanical power and postoperative pulmonary complications among young children undergoing video-assisted thoracic surgery: A retrospective study.

作者信息

Zhu Change, Zhang Rufang, Li Jia, Ren Lulu, Gu Zhiqing, Wei Rong, Zhang Mazhong

机构信息

From the Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai (CZ, MZ), Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai (LR, ZG, RW), Cardiothoracic Surgery Department, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (RZ, JL).

出版信息

Eur J Anaesthesiol. 2025 Jan 1;42(1):64-72. doi: 10.1097/EJA.0000000000002075. Epub 2024 Oct 16.

DOI:10.1097/EJA.0000000000002075

PMID:39628416

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11620292/

Abstract

BACKGROUND

Previous studies have discussed the correlation between mechanical power (MP) and lung injury. However, evidence regarding the relationship between MP and postoperative pulmonary complications (PPCs) in children remains limited, specifically during one-lung ventilation (OLV).

OBJECTIVES

Propensity score matching was employed to generate low MP and high MP groups to verify the relationship between MP and PPCs. Multivariable logistic regression was performed to identify risk factors of PPCs in young children undergoing video-assisted thoracic surgery (VATS).

DESIGN

A retrospective study.

SETTING

Single-site tertiary children's hospital.

PATIENTS

Children aged ≤2 years who underwent VATS between January 2018 and February 2023.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

The incidence of PPCs.

RESULTS

Overall, 581 (median age, 6 months [interquartile range: 5-9.24 months]) children were enrolled. The median [interquartile range] MP during OLV were 2.17 [1.84 to 2.64) J min-1. One hundred and nine (18.76%) children developed PPCs. MP decreased modestly during the study period (2.63 to 1.99 J min-1; P < 0.0001). In the propensity score matched cohort for MP (221 matched pairs), MP (median MP 2.63 vs. 1.84 J min-1) was not associated with a reduction in PPCs (adjusted odds ratio, 1.43; 95% CI, 0.87 to 2.37; P = 0.16). In the propensity score matched cohort for dynamic components of MP (139 matched pairs), dynamic components (mean 2.848 vs. 4.162 J min-1) was not associated with a reduction in PPCs (adjusted odds ratio, 1.62; 95% CI, 0.85 to 3.10; P = 0.15).The multiple logistic analysis revealed PPCs within 7 days of surgery were associated with male gender, OLV duration >90 min, less surgeon's experience and lower positive end-expiratory pressure (PEEP) value.

CONCLUSIONS

MP and dynamic components were not associated with PPCs in young children undergoing VATS, whereas PPCs were associated with male gender, OLV duration >90 min, less surgeon's experience and lower PEEP value.

TRIAL REGISTRATION

ChiCTR2300074649.

摘要

背景

既往研究探讨了机械功率（MP）与肺损伤之间的相关性。然而，关于MP与儿童术后肺部并发症（PPCs）之间关系的证据仍然有限，尤其是在单肺通气（OLV）期间。

目的

采用倾向评分匹配法生成低MP组和高MP组，以验证MP与PPCs之间的关系。进行多变量逻辑回归分析，以确定接受电视辅助胸腔镜手术（VATS）的幼儿发生PPCs的危险因素。

设计

一项回顾性研究。

地点

单中心三级儿童医院。

患者

2018年1月至2023年2月期间接受VATS的≤2岁儿童。

干预措施

无。

主要观察指标

PPCs的发生率。

结果

共纳入581名儿童（中位年龄6个月[四分位间距：5 - 9.24个月]）。OLV期间MP的中位数[四分位间距]为2.17[1.84至2.64]J·min⁻¹。109名（18.76%）儿童发生了PPCs。在研究期间MP略有下降（从2.63降至1.99 J·min⁻¹；P < 0.0001）。在MP倾向评分匹配队列（221对匹配）中，MP（中位MP 2.63 vs. 1.84 J·min⁻¹）与PPCs减少无关（调整后的比值比为1.43；95%可信区间为0.87至2.37；P = 0.16）。在MP动态成分倾向评分匹配队列（139对匹配）中，动态成分（均值2.848 vs. 4.162 J·min⁻¹）与PPCs减少无关（调整后的比值比为1.62；95%可信区间为0.85至3.10；P = 0.15）。多变量逻辑分析显示，术后7天内发生PPCs与男性性别、OLV持续时间>90分钟、外科医生经验较少以及呼气末正压（PEEP）值较低有关。