文献学习|欧洲麻醉实践-新生儿和婴儿早期麻醉后的发病率和死亡率：欧洲前瞻性多中心观察研究

需要麻醉的新生儿和婴儿处于麻醉状态有发生生理不稳定和并发症的风险，但是尚不清楚麻醉干预措施的触发因素以及与后续结果的关联。

这项前瞻性观察性研究在2016年3月至2017年1月期间，从31个欧洲国家的165个中心招募了修正月龄年龄长达60周的患者进行手术麻醉或诊断程序。主要目的是确定触发医疗干预的预先确定的生理变量的阈值。次要目标是评估发病率、30天和90天的死亡率，或两者兼而有之，以及与危急事件的关系。

平均年龄（标准差[sd]）为36.2（4.4）周的婴儿（n= 5609）（早产35.7％），在出生后63（48）天内接受了6542例检查。需要干预的严重事件发生在35.2％的病例中，主要是低血压（血压降低>30％）或氧合减少（SpO2<85％）。修正后的月龄影响了干预的发生率和门槛。先前发生的新生儿医学状况，先天性异常或两者兼有（相对风险[RR] = 1.16；95％置信区间[CI]为1.04-1.28）和需要术前强化支持的患者（RR=1.27; 95% CI, 1.15-1.41）会增加严重事件的风险。到30天时，16.3％的患者发生了其他并发症，而90天的总死亡率为3.2％（95％CI，2.7-3.7％）。术中低血压，低氧血症和贫血的并发与发病率（RR = 3.56；95％CI，1.64-7.71）和死亡率（RR = 19.80；95％CI，5.87-66.7）的增加相关。

引发干预的生理阈值的变化以及不良组织氧合对患者预后的影响，凸显了对新生儿和婴儿制定更加标准化的围手术期管理指南的需求。

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown.

Methods:   This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events.

Results:  Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04-1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15-1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7-3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64-7.71) and mortality (RR=19.80; 95% CI, 5.87-66.7).

Conclusion: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants.

 

原始文献： Disma N. Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE). Br J Anaesth. 2021 Mar 31:S0007-0912(21)00111-2. doi: 10.1016/j.bja.2021.02.016. Epub ahead of print. PMID: 33812668.