PDF(Pubmed)
Abstract：
OBJECTIVE: Cardiac surgery on cardiopulmonary bypass (CPB) during the neonatal period can cause perioperative organ injuries. The primary aim of this study was to determine the incidence and risk factors associated with postoperative mechanical ventilation duration and acute lung injury after the arterial switch operation (ASO). The secondary aim was to examine the utility of the Brixia score for characterizing postoperative acute lung injury (ALI).
METHODS: A retrospective study.
METHODS: A single-center university hospital.
METHODS: A total of 93 neonates with transposition of great arteries with intact ventricular septum (dTGA IVS) underwent ASO.
METHODS: None.
RESULTS: From January 2015 to December 2022, 93 neonates with dTGA IVS were included in the study. The cohort had a median age of 4.0 (3.0-5.0) days and a mean weight of 3.3 ± 0.5 kg. About 63% of patients had ≥48 hours of postoperative mechanical ventilation after ASO. Risk factors included prematurity, post-CPB transfusion of salvaged red cells, platelets and cryoprecipitate, and postoperative fluid balance by univariate analysis. The larger transfused platelet volume was associated with the risk of ALI by multivariate analysis. The median baseline Brixia scores were 11.0 (9.0-12.0) and increased significantly in the postoperative day 1 in patients who developed moderate ALI 24 hours after admission to the intensive care unit (15.0 [13.0-16.0] v 12.0 [10.0-14.0], p = 0.046).
CONCLUSIONS: Arterial switch operation results in a high incidence of ≥48-hour postoperative mechanical ventilation. Blood component transfusion is a potentially modifiable risk factor. The Brixia scores also may be used to characterize postoperative acute lung injury.
METHODS: A retrospective study.
METHODS: A single-center university hospital.
METHODS: A total of 93 neonates with transposition of great arteries with intact ventricular septum (dTGA IVS) underwent ASO.
METHODS: None.
RESULTS: From January 2015 to December 2022, 93 neonates with dTGA IVS were included in the study. The cohort had a median age of 4.0 (3.0-5.0) days and a mean weight of 3.3 ± 0.5 kg. About 63% of patients had ≥48 hours of postoperative mechanical ventilation after ASO. Risk factors included prematurity, post-CPB transfusion of salvaged red cells, platelets and cryoprecipitate, and postoperative fluid balance by univariate analysis. The larger transfused platelet volume was associated with the risk of ALI by multivariate analysis. The median baseline Brixia scores were 11.0 (9.0-12.0) and increased significantly in the postoperative day 1 in patients who developed moderate ALI 24 hours after admission to the intensive care unit (15.0 [13.0-16.0] v 12.0 [10.0-14.0], p = 0.046).
CONCLUSIONS: Arterial switch operation results in a high incidence of ≥48-hour postoperative mechanical ventilation. Blood component transfusion is a potentially modifiable risk factor. The Brixia scores also may be used to characterize postoperative acute lung injury.
摘要：
目的：新生儿期体外循环(CPB)心脏手术可引起围手术期脏器损伤。这项研究的主要目的是确定动脉转换手术（ASO）后与术后机械通气持续时间和急性肺损伤相关的发生率和危险因素。次要目的是检查Brixia评分在表征术后急性肺损伤（ALI）中的实用性。
方法：回顾性研究。
方法：单中心大学医院。
方法：共有93例大动脉转位伴室间隔完整（dTGAIVS）的新生儿接受了ASO。
方法：无。
结果：从2015年1月至2022年12月，93例dTGAIVS新生儿被纳入研究。该队列的中位年龄为4.0（3.0-5.0）天，平均体重为3.3±0.5kg。大约63％的患者在ASO后术后机械通气≥48小时。风险因素包括早产，CPB后输血挽救的红细胞，血小板和冷沉淀，单因素分析和术后液体平衡。通过多变量分析，较大的输注血小板体积与ALI的风险相关。中位基线Brixia评分为11.0（9.0-12.0），并且在入院后24小时出现中度ALI的患者在术后第1天显着增加（15.0[13.0-16.0]v12.0[10.0-14.0]，p=0.046)。
结论：动脉切换手术导致术后≥48小时机械通气的发生率很高。成分输血是一个潜在的可改变的危险因素。Brixia评分也可用于表征术后急性肺损伤。
方法：回顾性研究。
方法：单中心大学医院。
方法：共有93例大动脉转位伴室间隔完整（dTGAIVS）的新生儿接受了ASO。
方法：无。
结果：从2015年1月至2022年12月，93例dTGAIVS新生儿被纳入研究。该队列的中位年龄为4.0（3.0-5.0）天，平均体重为3.3±0.5kg。大约63％的患者在ASO后术后机械通气≥48小时。风险因素包括早产，CPB后输血挽救的红细胞，血小板和冷沉淀，单因素分析和术后液体平衡。通过多变量分析，较大的输注血小板体积与ALI的风险相关。中位基线Brixia评分为11.0（9.0-12.0），并且在入院后24小时出现中度ALI的患者在术后第1天显着增加（15.0[13.0-16.0]v12.0[10.0-14.0]，p=0.046)。
结论：动脉切换手术导致术后≥48小时机械通气的发生率很高。成分输血是一个潜在的可改变的危险因素。Brixia评分也可用于表征术后急性肺损伤。
