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DOI：
10.1097/01.ccm.0000550993.65202.ef
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发表时间：
2019-01
影响因子：
8.8
通讯作者：
Imran A. Sayed;V. Rajamanickam;P. Anagnostopoulos;Marlowe Eldridge;Scott A. Hagen;Awni M. Al-Subu
中科院分区：
文献类型：
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作者：
Imran A. Sayed;V. Rajamanickam;P. Anagnostopoulos;Marlowe Eldridge;Scott A. Hagen;Awni M. Al-Subu
方法：在三级儿童医院的PICU进行单中心回顾性研究。我们纳入了在体外循环下接受CHD手术修复后入住PICU的18岁以下患者，这些患者接受了至少24小时的有创机械通气。结果：在我们的研究期间（2012年1月至2016年8月），共有315名患者接受了体外循环下的CHD修复。103例患者符合入选标准。非存活者定义为手术后30天内死亡的患者（n= 10）。24小时时，非存活者的平均AVDSF为0.29 ± 0.07，存活者（n= 93）为0.15 ± 0.06（p= 0.01）。AVDSf每增加0.1，死亡率增加4.9 [95% CI= 1.9-12.2，p= 0.0005]。预测死亡率的AVDSf ROC曲线下面积为0.87 [95% CI，0.76-79]。术后24小时AVDSF> 0.25是医院死亡率的独立预测因子，敏感性和特异性分别为83%和81%。术后24小时内脑rSO 2的趋势也与死亡率相关（p= 0.01）。与存活者相比，死亡者rSO 2在最初8小时内升高，随后降低，死亡者rSO 2无变化，而存活者rSO 2有所改善。肾rSO 2随时间的绝对值和变化没有统计学意义之间的幸存者和nonsurvivers.Conclusions：增加AVDSF值在术后24小时与暴露于CPB的冠心病患者的死亡率。术后前24小时内脑rSO 2值的下降也与该患者人群的死亡率相关。
Methods: A single center retrospective review study in the PICU of a tertiary care children’s hospital. We included patients younger than 18 years of age admitted to the PICU after undergoing surgical repair of CHD on CPB who received invasive mechanical ventilation for at least 24 hours.Results: A total of 315 patients underwent CHD repair with CPB during our study period between January 2012 and August 2016. 103 patients met the inclusion criteria. Non-survivors were defined as patients who had mortality within 30 days of surgery (n= 10). Mean AVDSf at 24 hours for non-survivors was 0.29+ 0.07 and for survivors (n= 93) was 0.15+ 0.06 (p= 0.01). For every 0.1 increase in the AVDSf, the odds of mortality increased by 4.9 [95% CI= 1.9–12.2, p= 0.0005]. The area under the AVDSf ROC curve for predicting mortality was 0.87 [95% CI, 0.76–79]. An AVDSf> 0.25 at 24 hours post-operatively was an independent predictor of hospital mortality with sensitivity and specificity of 83% and 81% respectively. The trend in cerebral rSO2 in the 24 hours after surgery was also associated with mortality (p= 0.01). Compared with survivors, non-survivors had higher cerebral rSO2 in the first 8 hours followed by lower values, the cerebral rSO2 in non-survivor did not change, but it improved in survivors. Absolute values and changes in renal rSO2 over time were not statistically significant between the survivors and non-survivors.Conclusions: Increased AVDSf values at 24 hours post operatively is associated with mortality in patients with CHD exposed to CPB. A decline of cerebral rSO2 values in the first 24 hours post-operatively was also associated with mortality in this patient population.