Chronic hypoxia prolongs postoperative mechanical ventilation and reduces the left atrial pressure threshold in children with tetralogy of Fallot.
Chronic hypoxia prolongs postoperative mechanical ventilation and reduces the left atrial pressure threshold in children with tetralogy of Fallot.
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慢性缺氧延长法洛四联症患儿术后机械通气时间并降低左心房压力阈值
DOI：
10.3389/fped.2022.965703
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发表时间：
2022
影响因子：
2.6
通讯作者：
Yan, Fuxia
中科院分区：
文献类型：
--
作者：
Huang, Jiangshan;Ding, Jie;Wu, Xie;Jia, Yuan;Liu, Qiao;Yuan, Su;Yan, Fuxia
慢性缺氧诱导肺微血管内皮功能障碍。左心房压（LV）代表肺微循环的静水压力。肺微血管内皮屏障功能的异常与肺水肿的共同作用会对肺渗出产生影响，导致机械通气时间延长。本研究旨在探讨小儿法洛四联症（TOF）术后肺微循环对机械通气的耐受阈值，以避免术后长时间机械通气。这项回顾性研究包括297名在阜外医院接受TOF矫正术的中国患者。根据术前血氧饱和度（SpO2）水平对患者进行分类。一对一倾向评分匹配（PSM）显示SpO2 <90%和SpO2 ≥ 90%组共有126名参与者。进行组间比较，以验证缺氧和长时间机械通气之间的相关性。进行亚组分析，以揭示术后监护对延长机械通气的重要作用。在术前SpO2 <90%的儿童中，前48 h内拔管失败（23.81% vs. 9.52%，P = 0.031）和机械通气时间延长（26.98% vs. 11.11%，P = 0.023）更常见。 在SpO2 <90%和SpO2 ≥ 90%两组中，延长机械通气的发生率随着SpO2的增加而增加，尽管SpO2仍在正常范围内（6 - 12 mmHg）。 慢性缺氧条件下的儿童耐受性较低。在慢性缺氧条件下诊断为TOF的儿童的术后再灌注耐受阈值被确定为7 mmHg。 处于慢性缺氧状态的儿童在TOF手术矫正后可能会遭受长时间机械通气的高发生率，并且可能无法耐受较高的术后呼吸。慢性缺氧患儿术后应控制并维持较低的肺动脉压（≤ 7 mmHg），以改善肺功能预后。
Chronic hypoxia induces pulmonary microvascular endothelial dysfunction. The left atrial pressure (LAP) represents the hydrostatic pressure of pulmonary microcirculation. The conjunction of the LAP and any abnormal pulmonary microvascular endothelial barrier function will have an impact on pulmonary exudation, resulting in prolonged mechanical ventilation. This study aimed to investigate the tolerance threshold of the pulmonary microcirculation to LAP in children with tetralogy of Fallot (TOF) to avoid prolonged mechanical ventilation after surgery. This retrospective study included 297 Chinese patients who underwent TOF correction at Fuwai Hospital. Patients were categorized according to their preoperative oxygen saturation (SpO2) level. One-to-one propensity score matching (PSM) revealed a total of 126 participants in the SpO2 < 90% and SpO2 ≥ 90% groups. Between-group comparisons were conducted to verify the correlation between hypoxia and prolonged mechanical ventilation. A subgroup analysis was performed to reveal the significant role of postoperative LAP stewardship on prolonged mechanical ventilation. Failure to extubate within the first 48 h (23.81% vs. 9.52%, P = 0.031) and prolonged mechanical ventilation (26.98% vs. 11.11%, P = 0.023) were more commonly observed in children with preoperative SpO2 < 90%. The incidence of prolonged mechanical ventilation consistently increased with LAP in both the SpO2 < 90% and SpO2 ≥ 90% groups, although LAP was still within the normal range (6–12 mmHg). Children in chronic hypoxic conditions tolerated lower LAP well. The tolerance threshold for postoperative LAP in children diagnosed with TOF under chronic hypoxic conditions was identified as 7 mmHg. Children in a chronic hypoxic state may suffer from a high incidence of prolonged mechanical ventilation after surgical correction of TOF and may not tolerate higher postoperative LAP. To improve pulmonary prognosis, it is better to control and maintain the postoperative LAP at a lower state (≤7 mmHg) in children with chronic hypoxia.
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