Factors Associated with Postoperative Respiratory Complications following Posterior Spinal Instrumentation in Children with Early-onset Scoliosis.
Factors Associated with Postoperative Respiratory Complications following Posterior Spinal Instrumentation in Children with Early-onset Scoliosis.
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与早发性脊柱侧凸儿童后路脊柱内固定术后呼吸系统并发症相关的因素
DOI：
10.1111/os.13351
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发表时间：
2022-07
影响因子：
2.1
通讯作者：
Li, Wuyao
中科院分区：
文献类型：
--
作者：
Zhang, Ying;Wang, Yingsong;Xie, Jingming;Bi, Ni;Zhao, Zhi;Li, Tao;Shi, Zhiyue;Huang, Tianyi;Gao, Bing;Gu, Kaiwen;Li, Wuyao
探讨儿童早发性脊柱侧凸（EOS）基于生长友好技术的脊柱后路畸形手术（PSDS）术后呼吸系统并发症（PRCs）的发生率及危险因素，以帮助提高手术的安全性。对2013年10月至2018年10月期间基于生长友好技术因PSDS入院的EOS儿童的回顾性研究进行了审查。共有73名儿童（30名男孩，43名女孩）符合本研究的标准。患者的平均年龄为7 ± 6.2岁。将患者分为有和无PRCs组。采用单因素分析法对围手术期可能影响PRCs发生的因素进行分析，包括一般因素、影像学因素、实验室因素和手术因素。对差异有统计学意义的变量进一步进行二项Logistic回归分析，以确定PRCs的独立因素。其中特发性脊柱侧凸42例（57.5%），先天性脊柱侧凸12例（16.4%），综合征性脊柱侧凸10例（13.7%），神经肌肉性脊柱侧凸9例（12.3%）。在16名儿童（21.9%）中检测到9种不同的PRCs。PRCs的总检出率为54，包括胸腔积液（25.9%），术后肺炎（20.4%），低氧血症（18.5%），肺不张（14.8%）、机械正压通气支持下延长插管（PIMPPVS）（7.4%）、支气管痉挛（3.7%）、重新插管（3.7%）、延迟拔管（3.7%）和气胸（1.9%）。单因素检验结果显示：非特发性脊柱侧凸、合并肺部合并症、前转铁蛋白< 200 mg/dL、前白蛋白< 3.5 g/dL、麻醉时间≥ 300 min、失血量/总血容量比（BL/TBV）≥ 15% 6个变量差异有统计学意义（P < 0.05）。二元Logistic回归分析证实BL/TBV≥15%（比值比OR = 29.188，P = 0.010），合并肺部合并症（OR = 19.216，P = 0.012），前转铁蛋白< 200 mg/dL（OR = 11.503，p = 0.024）和非特发性脊柱侧凸（OR = 7.632，P = 0.046）与EOS儿童PSDS后的PRC呈正线性相关。PSDS后EOS儿童的PRCs发生率较高。BL/TBV ≥ 15%，合并肺部合并症，前转铁蛋白< 200 mg/dL和非特发性脊柱侧凸在该人群中PRC的发展中起重要作用。早发性脊柱侧凸（EOS）患者在后路脊柱畸形手术（PSDS）后，术后呼吸系统并发症（PRC）的发生率为21.9%。最常见的PRCs是胸腔积液。PRC的危险因素为BL/TBV ≥ 15%、合并肺部合并症、前转铁蛋白< 200 mg/dL和非特发性脊柱侧凸。
To investigate the incidence and risk factors of postoperative respiratory complications (PRCs) in children with early‐onset scoliosis (EOS) following posterior spine deformity surgery (PSDS) based on growth‐friendly techniques, so as to help improve the safety of surgery. A retrospective study of children with EOS admitted for PSDS based on growth‐friendly techniques from October 2013 to October 2018 was reviewed at a single center. There were 73 children (30 boys, 43 girls) who fulfilled the criteria in this research. The mean age of the patients was 7 ± 6.2 years. Patients were divided into the groups with and without PRCs. Variables that might affect the PRCs during the perioperative period, including general factors, radiographic factors, laboratory factors and surgical factors, were analyzed using univariate analysis to evaluate the potential risk factors. The variables that were significantly different were further analyzed by binary logistic regression analysis to identify the independent factors of PRCs. All the 73 children included 42 idiopathic scoliosis (57.5%), 12 congenital scoliosis (16.4%), 10 syndromic scoliosis (13.7%) and nine neuromuscular scoliosis (12.3%). PRCs were detected in 16 children (21.9%) with nine different PRCs. The total frequency of detected PRCs was 54, including pleural effusion (25.9%), postoperative pneumonia (20.4%), hypoxemia (18.5%), atelectasis (14.8%), prolonged intubation with mechanical positive pressure ventilatory support (PIMPPVS) (7.4%), bronchospasm (3.7%), reintubation (3.7%), delayed extubation (3.7%) and pneumothorax (1.9%). Results of univariate testing demonstrated that the following six variables were statistically different (P < 0.05): nonidiopathic scoliosis, combined with pulmonary comorbidities, pretransferrin < 200 mg/dL, prealbumin < 3.5 g/dL, anesthesia time ≥ 300 min and blood loss to total blood volume ratio (BL/TBV) ≥ 15%. Binary logistic regression analysis confirmed that BL/TBV≥15% (odd ratio OR = 29.188, P = 0.010), combined with pulmonary comorbidities (OR = 19.216, P = 0.012), pretransferrin < 200 mg/dL (OR = 11.503, p = 0.024), and nonidiopathic scoliosis (OR = 7.632, P = 0.046) were positively linear correlated with PRCs in children with EOS following PSDS. PRCs has a higher incidence in children with EOS following PSDS. BL/TBV ≥15%, combined with pulmonary comorbidities, pre‐transferrin < 200 mg/dL, and nonidiopathic scoliosis play an important role for the development of PRCs in this population. An incidence of 21.9% postoperative respiratory complications (PRCs) was observed in early‐onset scoliosis (EOS) patients after posterior spine deformity surgery (PSDS). The most frequent PRCs was pleural effusion. Risk factors of PRCs were BL/TBV ≥15%, a combination of pulmonary comorbidities, pretransferrin < 200 mg/dL and nonidiopathic scoliosis.
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