接受综合 II 期手术的左心发育不全综合征患者围手术期的麻醉管理--对 148 例病例的回顾。

IF 1.7 4区 医学 Q2 ANESTHESIOLOGY
Pediatric Anesthesia Pub Date : 2024-12-01 Epub Date: 2024-09-08 DOI:10.1111/pan.14995
Matthias Müller, Florian Lurz, Thomas Zajonz, Fabian Edinger, Uygar Yörüker, Josef Thul, Dietmar Schranz, Hakan Akintürk
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引用次数: 0

摘要

背景:左心发育不全综合征患者接受综合二期手术,这是实现丰坦循环混合方法的第二阶段。综合二期手术的复杂性被认为是一个潜在的限制因素,有关其麻醉管理的信息也很有限。本研究旨在填补这一空白:单中心回顾性队列研究分析了148例接受综合二期手术的HLHS患者,分为A组(病情稳定,n = 116)和B组(需要术前静脉注射肌力治疗,n = 32)。收集了人口统计学数据、术中血流动力学、麻醉管理和术后结果:依托咪酯(40%)是最常用的诱导药物,其次是艾司卡胺(24%)、咪达唑仑(16%)和异丙酚(13%)。吸入诱导很少需要(2%),仅在 A 组患者中出现。在诱导药物的选择上,各组之间没有统计学差异。心肺旁路术后管理包括中度通气不足、吸入一氧化氮(100%)以及米力农(97%)和去甲肾上腺素(77%)的血流动力学支持。B 组患者更经常需要额外的左西孟旦(20%)和肾上腺素(18%)。8名患者(5%)需要体外膜肺氧合,组间无差异。将芬太尼改为瑞芬太尼总体上缩短了术后通气时间。然而,B 组患者的通气时间(6.3 小时对 3.5 小时)和重症监护室住院时间(22 天对 14 天)明显更长。院内死亡率为 5%(A 组:4%,B 组:9%)。长期生存分析显示,A组具有明显优势:结论:使用短效阿片类药物和调整通气模式可优化肺血流并快速过渡到自主呼吸。对高危患者使用米力农、去甲肾上腺素,辅以左西孟旦和肾上腺素进行不同的血流动力学支持,可减轻对术前容量负荷右心室的影响。不过,观察到不同组间的长期生存概率存在差异:试验注册:Justus-Liebig-University-Giessen 大学医学院地方伦理委员会(试验代码:216/14)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perioperative anesthetic management of patients with hypoplastic left heart syndrome undergoing the comprehensive stage II surgery-A review of 148 cases.

Background: Patients with hypoplastic left heart syndrome undergo the comprehensive stage 2 procedure as the second stage in the hybrid approach toward Fontan circulation. The complexity of comprehensive stage 2 procedure is considered a potential limitation, and limited information is available on its anesthetic management. This study aims to address this gap.

Methods: A single-center retrospective cohort study analyzed 148 HLHS patients who underwent comprehensive stage 2 procedure, divided into Group A (stable condition, n = 116) and Group B (requiring preoperative intravenous inotropic therapy, n = 32). Demographic data, intraoperative hemodynamics, anesthetic management, and postoperative outcomes were collected.

Results: Etomidate (40%) was the most common induction agent, followed by esketamine (24%), midazolam (16%), and propofol (13%). Inhaled induction was rarely necessary (2%), occurring only in Group A patients. No statistical differences were found between groups for induction drug choice. Post-cardiopulmonary bypass management included moderate hypoventilation, inhaled nitric oxide (100%), and hemodynamic support with milrinone (97%) and norepinephrine (77%). Group B patients more frequently required additional levosimendan (20%) and epinephrine (18%). Extracorporeal membrane oxygenation was necessary in 8 patients (5%) with no between-group differences. Switching from fentanyl to remifentanil reduced postoperative ventilation time overall. However, Group B experienced significantly longer ventilation (6.3 vs. 3.5 h) and ICU stay (22 vs. 14 days). In-hospital mortality was 5% overall (Group A: 4%, Group B: 9%). Long-term survival analysis revealed a significant advantage for Group A.

Conclusion: The use of short-acting opioids and adjusted ventilation modes enables optimal pulmonary blood flow and rapid transition to spontaneous breathing. Differentiated hemodynamic support with milrinone, norepinephrine, supplemented by levosimendan and epinephrine in high-risk patients, can mitigate the effects on the preoperatively volume-loaded right ventricle. However, differences in long-term survival probability were observed between groups.

Trial registration: Local ethics committee, Medical Faculty, Justus-Liebig-University-Giessen (Trial Code Number: 216/14).

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来源期刊
Pediatric Anesthesia
Pediatric Anesthesia 医学-麻醉学
CiteScore
3.20
自引率
11.80%
发文量
222
审稿时长
3-8 weeks
期刊介绍: Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.
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