在儿科手术入院中,经过外科手术期间的侵入性机械通风后的神经发育和行为障碍
Oliver G Isik1, Ling Guo1, Ariel Ben-Ezra1
1Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
British journal of anaesthesia
|March 14, 2025
概括
在手术期间需要侵入性机械通风 (IMV) 的儿童面临神经发育和行为障碍 (NDBD) 的更高风险. 长时间的IMV,特别是超过96小时,在出院后显著增加这些风险.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 神经发育障碍 神经发育障碍
- 外科手术的结果
背景情况:
- 在儿科重症监护室 (PICU) 需要侵入性机械通风 (IMV) 的儿童患神经发育和行为障碍 (NDBD) 的风险更高.
- 这项研究专门研究了在接受手术并接受IMV的儿童中进行NDBD的研究.
研究的目的:
- 评估在外科住院期间接受入侵性机械通风 (IMV) 的儿童中出现出院后神经发育和行为障碍 (NDBD) 的风险.
- 分析IMV持续时间与NDBD风险之间的关联.
- 检查出院后使用心理药物和IMV暴露之间的关系.
主要方法:
- 一个回顾性队列研究使用德克萨斯州医疗补助数据从1999-2012.
- 确定了手术入院的儿童,将他们分类为有IMV的PICU,没有IMV的PICU和中间医疗保健单位 (IMCU) 组.
- 将这些组与入院一般病房的儿童相匹配,并分析出院后的NDBD率,IMV持续时间和精神药物使用.
主要成果:
- 在外科住院期间接受IMV治疗的儿童的NDBD发病率明显高 (HR 1.91).
- 在没有IMV或IMCU的PICU中的儿童中,没有发现增加的NDBD率.
- 增加的NDBD风险主要与IMV持续时间为96小时或更长时间有关,只有IMV组观察到增加的精神药物使用.
结论:
- 手术入院期间的侵入性机械通风与儿童出院后神经发育和行为障碍的风险增加有关.
- 需要进一步的研究,以了解潜在的机制,并确定潜在的可修改的风险因素.
- 这些发现强调了监测经过IMV的儿科外科患者神经发育结果的重要性.
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