在全身麻醉和心脏导管治疗后心脏功能下降,儿童心脏移植接受者
Gokul Thimmarayan1, Michael Schmitz1, Beverly J Spray2
1Departments of Anesthesiology and Pain Medicine, Section of Pediatric Cardiac Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, US.
Seminars in cardiothoracic and vascular anesthesia
|December 2, 2024
概括
心脏功能下降发生在25%的儿科心脏移植患者在一般麻醉过程中程序. 高龄化,使用ACE抑制剂和右心室末端扩张压的升高预测了这种下降.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 麻醉学 麻醉学
- 移植医学 移植医学 移植医学
背景情况:
- 儿童心脏移植接受者经常在全身麻醉 (GA) 下接受心脏导管和内肌心脏活检 (CC/EMB) 等手术.
- 全身麻醉和正压通风 (PPV) 可以抑制心脏功能,可能会混移植评估.
- 这项研究调查了GA/PPV对这些患者心脏功能的影响.
研究的目的:
- 确定心脏功能从清醒到麻醉状态下心脏功能下降的频率,在儿科心脏移植接受者.
- 为了确定与这种心脏功能下降相关的患者相关和麻醉因素.
主要方法:
- 对于儿童心脏移植接受者在GA/PPV下接受CC/EMB的电子病历的回顾性审查.
- 纳入标准:醒来时心脏功能正常 (左心室缩短分数 (LVSF) ≥28%) 在手术前进行评估.
- 心脏功能下降定义为术后的LVSF<28%.
主要成果:
- 心脏功能下降发生在17.3%的遭遇和25%的患者中.
- 衰退的独立预测因素包括年龄 (OR 1.4),血管酶转化酶抑制剂 (ACEI) 使用 (OR 2.5) 和右心室末端扩张压升高 (RVEDP) (OR 2.4).
- 高龄与ACEI使用和RVEDP升高相关.
结论:
- 大约四分之一的儿科心脏移植患者在从清醒状态过渡到麻醉状态时经历心脏功能下降.
- 这种下降在使用ACE抑制剂的RVEDP升高的老年儿童中最为普遍.
- 观察到的心脏功能下降通常不能归因于移植器的排斥.
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