术前神经病理并发症和预期不到的早期术后再输管:一个多中心队列研究
Christian Mpody1, Rachel C Kidwell2, Brittany L Willer1
1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
British journal of anaesthesia
|September 20, 2024
概括
患有神经相关疾病的儿童在手术后面临更高的再输管和长时间通风风险. 这些情况显著增加了呼吸系统不良结果和死亡率的可能性,需要更密切的监测.
科学领域:
- 儿科手术 儿科手术
- 神经学 神经学
- 关键护理医学 关键护理医学
背景情况:
- 手术后的呼吸道并发症在手术后的最初72小时内具有最高风险.
- 这些事件可能会加剧现有的呼吸系统问题,并导致重新输管,特别是在患有神经疾病的儿童中.
研究的目的:
- 为了研究神经病理并发症和儿科手术患者预期不到的早期术后再灌输之间的关联.
主要方法:
- 一项多中心,倾向分数匹配的研究包括420,096名儿童,他们在2012年至2022年期间接受了选择性非心脏手术.
- 主要结局是72小时内重新输管;次要结局包括延长机械呼吸和30天死亡率.
主要成果:
- 大脑麻呈现出早期再灌管风险最高 (aRR: 1.97),其次是发作障碍 (aRR: 1.87),神经肌肉障碍 (aRR: 1.76) 和中枢神经系统异常 (aRR: 1.35).
- 早期再灌输使30天死亡风险增加了8倍 (aHR:8.1). 神经相关疾病也增加了长时间机械呼吸的风险,特别是发作 (aRR: 1.73).
结论:
- 患有神经病并发症的儿童在手术后出现早期再输管和长时间机械通风的风险较高.
- 加强监测和风险评估对于这些儿童至关重要,因为与此相关的死亡风险很大.
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