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儿童心脏手术后输出管失败的危险因素和对结果的影响:多中心分析
Jonathan Byrnes1, David Bailly2, David K Werho3
1Division of Cardiology, Department of Pediatrics, University of Alabama, Birmingham, AL.
Critical care explorations
|September 27, 2023
概括
在儿科心脏外科手术中,输出失败 (EF) 会增加死亡率和停留时间. 识别可修改的风险因素,如输管路线和时间,可以帮助降低EF率.
科学领域:
- 儿科心脏手术 儿科心脏手术
- 关键护理医学 关键护理医学
- 输出管的管理管理.
背景情况:
- 儿科心脏手术后的输出失败 (EF) 是与增加发病率和死亡率相关的重大并发症.
- 了解早期和晚期EF的不同风险因素对于改善患者的治疗结果至关重要.
研究的目的:
- 确定儿童心脏手术后早期 (48小时内) 和晚期 (48-168小时) 输出管失败的危险因素.
- 探索与早期和晚期EF相关的临床影响,包括死亡率和停留时间.
主要方法:
- 这是一项回顾性队列研究,利用从儿科心脏病重症监护联盟 (PC4) 登记处前性收集的数据.
- 分析包括2013年至2018年期间接受基准心脏手术或心脏移植的儿科患者.
- 分析了EF的人口统计和风险因素,重点关注潜在的可修改因素和临床结果,如死亡率和停留时间 (LOS).
主要成果:
- 这项研究分析了18,278次口,早期EF率为5.2%,晚期EF为2.5%.
- 心肺绕道时间,呼吸器持续时间,气道异常,遗传异常,多发流和隔膜与早期和晚期EF有关.
- 在白天 (远离轮班变更) 进行输出管和鼻内输入管降低了早期EF风险,而手术室输出管增加了早期EF风险,但降低了晚期EF风险.
结论:
- 早期和晚期的输出失败都显著增加了儿科心脏手术患者的住院时间和死亡率.
- 这些发现提供了按手术类型分层的基准数据.
- 可修改的因素,如输管路线,输出时间,以及对隔膜麻或多叶膜溢液等疾病的管理,为减少EF提供了机会.
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