Systemic inflammatory response syndrome after pediatric congenital heart surgery: Incidence, risk factors, and clinical outcome
Systemic inflammatory response syndrome after pediatric congenital heart surgery: Incidence, risk factors, and clinical outcome
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DOI：
10.1111/jocs.12879
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发表时间：
2017-02-01
影响因子：
1.6
通讯作者：
Jack, Thomas
中科院分区：
文献类型：
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作者：
Boehne, Martin;Sasse, Michael;Jack, Thomas
背景技术背景：全身炎症反应综合征（SIRS）是常见的心脏手术后，但其发病率和围手术期的危险因素的数据是稀缺的先天性心脏病children with congenital heartdisease.METHODS：SIRS发病率在心脏手术后72小时内进行了评估，在二次分析的儿童参加了一项随机对照试验的无治疗对照组。使用多变量分数多项式逻辑回归模型研究了术中参数与SIRS的相关性。使用随时间变化的考克斯回归models.Results：在116名儿童心脏手术后（中位数年龄[范围]：7.4个月[1天-16.2岁]）SIRS发生在n = 39/102和n = 1/14没有心肺转流（CPB）的各种器官功能和住院时间的影响进行了评估。CPB持续时间（风险比[HR]：2.28/小时; 95%置信区间[CI] 1.17; 4.42）和新鲜冷冻血浆量（HR：1.23/10 mL/kg; 95% CI 1.06; 1.42）被确定为SIRS的预测因子;新生儿似乎对SIRS的发生不太敏感（HR：0.86; 95% CI 0.79; 0.95）。SIRS与器官功能障碍（HR：2.69; 95%CI 1.41; 5.12）和儿科重症监护室（PICU）的延长住院时间（中位数：168 vs. 96小时; p = 0.007）相关。结论：SIRS是儿科先天性心脏病手术后的常见并发症;它影响近三分之一的儿童和PICU住院时间。CPB持续时间和新鲜冷冻血浆量被确定为重要的风险因素。新生儿似乎对SIRS的发展不太敏感。
BACKGROUND: Systemic inflammatory response syndrome (SIRS) is frequent after cardiac surgery, but data on its incidence and perioperative risk factors are scarce for children with congenital heart disease.METHODS: SIRS incidence within 72 hours following cardiac surgery was evaluated in a secondary analysis of children enrolled to a treatment-free control group of a randomized controlled trial. Intraoperative parameters were investigated for their association with SIRS using multivariable fractional polynomial logistic regression models. Effects of SIRS on various organ functions and length of stay were evaluated using time-varying Cox regression models.RESULTS: In 116 children after cardiac surgery (median age [range]: 7.4 month [1 day-16.2 years]) SIRS occurred in n = 39/102 with and n = 1/14 without cardiopulmonary bypass (CPB). Duration of CPB (hazard ratio [HR]: 2.28 per hour; 95% confidence interval [CI] 1.17; 4.42) and amount of fresh frozen plasma (HR: 1.23 per 10 mL/kg; 95% CI 1.06; 1.42) were identified as predictors for SIRS; neonates seemed to be less susceptible for SIRS development (HR: 0.86; 95% CI 0.79; 0.95). SIRS was associated with organ dysfunction (HR: 2.69; 95% CI 1.41; 5.12) and extended stay in the pediatric intensive care unit (PICU) (median: 168 vs. 96 hours; p = 0.007).CONCLUSIONS: SIRS is a frequent complication after pediatric congenital heart surgery; it affects nearly one third of children and prolongs PICU stay significantly. Duration of CPB and amount of fresh frozen plasma were identified as important risk factors. Neonates seem to be less susceptible to SIRS development.