肥厚性幽门狭窄婴儿围手术期的低氧血症和术后呼吸事件。

IF 1.5 3区医学 Q2 PEDIATRICS

European Journal of Pediatric Surgery Pub Date : 2023-12-01 Epub Date: 2022-11-23 DOI:10.1055/a-1984-9803

Fenne A I M van den Bunder, Markus F Stevens, Job B M van Woensel, Tim van de Brug, L W Ernest van Heurn, Joep P M Derikx

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引用次数: 0

摘要

背景：使代谢性碱中毒恢复正常是治疗婴儿肥厚性幽门狭窄（IHPS）的重要支柱，因为未纠正的代谢性碱中毒可能导致围手术期呼吸系统事件。然而，有关呼吸系统事件发生率的证据却很有限。我们旨在研究接受幽门切开术的婴儿围术期低氧血症和术后呼吸事件的发生率以及代谢性碱中毒的潜在作用：我们回顾性研究了2007年至2017年间接受幽门切除术的所有患者。所有婴儿术前都接受了静脉输液，以纠正接近正常的代谢异常。我们评估了围手术期低氧血症（定义为血氧饱和度 [SpO2] 1 分钟）和术后呼吸事件的发生率。此外，我们还评估了困难插管的发生率。我们进行了多变量逻辑回归分析，以评估入院或术前血清pH值、碳酸氢盐或氯化物与围手术期和术后低氧血症或呼吸事件之间的关联：在纳入的 406 例婴儿中，有 208 例（51%）在围手术期出现过 1 次或 1 次以上的低氧血症，其中 130 例（32%）在诱导过程中出现低氧血症，43 例（11%）在术中出现低氧血症，112 例（28%）在苏醒过程中出现低氧血症。约 7.5%的婴儿插管困难，17 名婴儿需要儿科麻醉师进行 3 次以上的插管尝试。有 3 名患者出现呼吸功能不全，95 例术后呼吸事件。我们没有发现反映代谢性碱中毒的实验室值与呼吸事件之间存在有临床意义的关联：结论：IHPS 经常导致围手术期和术后低氧血症或呼吸事件，气管插管困难的发生率也很高。术前pH值、碳酸氢盐和氯化物是预测呼吸事件的不良指标。

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Perioperative Hypoxemia and Postoperative Respiratory Events in Infants with Hypertrophic Pyloric Stenosis.

Background: Normalization of metabolic alkalosis is an important pillar in the treatment of infantile hypertrophic pyloric stenosis (IHPS) because uncorrected metabolic alkalosis may lead to perioperative respiratory events. However, the evidence on the incidence of respiratory events is limited. We aimed to study the incidence of peroperative hypoxemia and postoperative respiratory events in infants undergoing pyloromyotomy and the potential role of metabolic alkalosis.

Materials and methods: We retrospectively reviewed all patients undergoing pyloromyotomy between 2007 and 2017. All infants received intravenous fluids preoperatively to correct metabolic abnormalities close to normal. We assessed the incidence of perioperative hypoxemia (defined as oxygen saturation [SpO₂] < 90% for > 1min) and postoperative respiratory events. Additionally, the incidence of difficult intubations was evaluated. We performed a multivariate logistic regression analysis to evaluate the association between admission or preoperative serum pH values, bicarbonate or chloride, and peri- and postoperative hypoxemia or respiratory events.

Results: Of 406 included infants, 208 (51%) developed 1 or more episodes of hypoxemia during the perioperative period, of whom 130 (32%) experienced it during induction, 43 (11%) intraoperatively, and 112 (28%) during emergence. About 7.5% of the infants had a difficult intubation and 17 required more than 3 attempts by a pediatric anesthesiologist. Three patients developed respiratory insufficiency and 95 postoperative respiratory events were noticed. We did not find a clinically meaningful association between laboratory values reflecting metabolic alkalosis and respiratory events.

Conclusions: IHPS frequently leads to peri- and postoperative hypoxemia or respiratory events and high incidence of difficult tracheal intubations. Preoperative pH, bicarbonate, and chloride were bad predictors of respiratory events.

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来源期刊

European Journal of Pediatric Surgery 医学-外科

CiteScore

3.90

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.