先天性心脏病围手术期预后：四种常见冠心病手术中延长通气时间和住院时间相关临床因素的综述

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2025-03-01 DOI:10.1053/j.jvca.2024.11.008

A. Rebecca L. Hamilton MD, MSc , Koichi Yuki MD, MBA , Francis Fynn-Thompson MD , James A. DiNardo MD , Kirsten C. Odegard MD, MBA

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引用次数: 0

摘要

目的：低风险先天性心脏病（CHD）手术的围手术期管理策略和结果因机构而异。迄今为止，对儿科心脏手术患者的标准化管理尚未达成共识。本研究旨在对4种常见冠心病病变的围手术期处理进行基准分析，并探讨影响术后预后的临床因素。设计：对2015年至2020年间进行的冠心病手术进行回顾性回顾。环境：本研究是在一个单一的学术三级儿科医院进行的。参与者：所有提出修复室间隔缺损（VSDs），完全性房室管缺损，法洛四联症（TOF）和大动脉转位（TGA）的患者进行了回顾。干预措施：收集人口统计和临床数据；临床结果定义为术后通气时间（LOV）和住院时间，分为参考组和延长疗程组，分析与结果差异相关的变量。测量方法和主要结果：我们选择了931例患者进行回顾。在所有队列中，延长通气时间和住院时间与较长的手术时间、体外循环时间和交叉钳夹时间相关；术中对肌力支持的要求较高；输血量增加和阿片类药物用量增加；术前低pH，术后高乳酸。较差的结果与VSD患者年龄较小、TGA患者年龄较大、TOF和TGA患者体重较低相关。较差的结果还与VSD和TOF的术前红细胞压积升高以及VSD和TGA的术前血糖升高有关。结论：更好地了解影响预后的临床因素可能有助于简化儿童低风险心脏手术患者的围手术期管理策略。

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Perioperative Outcomes in Congenital Heart Disease: A Review of Clinical Factors Associated With Prolonged Ventilation and Length of Stay in Four Common CHD Operations

Objectives

Perioperative management strategies and outcomes for low-risk congenital heart disease (CHD) surgery vary between institutions. To date, no consensus exists on standardized management for pediatric patients undergoing cardiac surgery. This study seeks to benchmark the perioperative management of 4 common CHD lesions and explore clinical factors affecting postoperative outcomes.

Design

A retrospective review of CHD procedures performed between 2015 and 2020.

Setting

The study was conducted at a single academic tertiary pediatric hospital.

Participants

All patients presenting for repair of ventricular septal defects (VSDs), complete atrioventricular canal defects, tetralogy of Fallot (TOF), and transposition of the great arteries (TGA) were reviewed.

Interventions

Demographic and clinical data were collected; clinical outcomes were defined as postoperative length of ventilation (LOV) and hospital length of stay, divided into reference and prolonged course groups analyzed for variables associated with differences in outcomes.

Measurements and Main Results

We selected 931 patients for review. Prolonged length of ventilation and length of stay in all cohorts were associated with longer operative, cardiopulmonary bypass, and cross-clamp times; higher intraoperative requirements for inotropic support; more blood transfusions and higher opioid administration; lower pH preoperatively and higher lactic acid postoperatively. Worse outcomes were associated with younger age in VSD, older age in TGA, and lower weight in TOF and TGA. Worse outcomes were also associated with a higher preoperative hematocrit in VSD and TOF and elevated preoperative blood glucose in VSD and TGA.

Conclusions

A better understanding of clinical factors affecting outcomes may facilitate streamlining perioperative management strategies for pediatric patients undergoing low-risk cardiac surgery.

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来源期刊

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

期刊介绍： The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.