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耐火性胆胸部:术后胆胸部儿童的描述性分析和预测模型
Deborah U Frank1, Cameron T Kasmai2, Melissa M Winder3
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Virginia, Arlington, VA, USA.
Pediatric cardiology
|February 25, 2025
概括
儿科心脏手术后延长的胸,定义为长胸 (LC),与增加的并发症和资源使用有关. 在术后第7天的高胸管输出可以预测LC,有助于早期干预.
科学领域:
- 儿科心脏手术 儿科心脏手术
- 胸部外科手术 胸部外科手术
- 关键护理医学 关键护理医学
背景情况:
- 胸是小儿心脏手术后的一种严重并发症,与增加的发病率和死亡率有关.
- 临床结果比较长期与快速解决的胆胸部仍然未得到充分研究.
- 了解长期胆胸病的风险因素对于优化患者管理至关重要.
研究的目的:
- 在儿童心脏外科手术患者中,描述长期胆胸部 (长胆胸部,LC) 与迅速解决 (短胆胸部,SC) 的临床结果.
- 为了确定患者的特征和与LC相关的临床事件.
- 评估术后第7天的胸管输出量,作为LC的预测指标.
主要方法:
- 在八个美国儿科心脏病重症监护室进行了回顾性队列研究.
- 包括18岁以下的患者,在心脏手术后30天内接受了胆胸部治疗 (不包括Fontan).
- 定义LC为胸管持续时间≥14天;SC为<14天. 使用后勤回归进行分析.
主要成果:
- 134名患者患有胆胸;51人 (38%) 患有LC. 随着手术复杂性的增加,LC的比例增加.
- 慢性肺炎患者的诊断时间较晚,机械通风时间较长,ICU/住院时间较长.
- 高胸管输出量 (>20毫升/公斤) 在POD7预测LC (aOR 7.3);败血症/CLABSI (aOR 8.8) 和开放的胸骨 (aOR 3.3) 与LC有关.
结论:
- 长长的胸与儿科心脏手术患者的资源利用率和发病率增加有关.
- 术后第7天的胸管输出可以预测LC,从而可以更早地识别风险患者.
- 针对LC的量身定制的治疗策略可能会改善这一脆弱人群的治疗结果.
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