脊柱侧弯后路融合术儿童术前肺功能检测结果与术后插管无关：回顾性观察研究
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Preoperative Pulmonary Function Test Results Are Not Associated With Postoperative Intubation in Children Undergoing Posterior Spinal Fusion for Scoliosis: A Retrospective Observational Study
背景与目的
尽管作为围手术期风险评估工具的益处尚不明确，且患者经常无法提供满意的信息，但脊柱侧弯患儿接受脊柱后路融合后仍需常规进行术前肺功能测试。本研究的目的是确定术前肺功能测试结果是否与术后插管或后路脊柱融合术后重症监护病房入院率相关。
方 法
回顾了2012年6月至2017年8月在某儿科三级医院行后路脊柱融合术患者的电子病历。所有患者均一致要求进行肺功能测试，除非患者因认知功能障碍而被认为无法进行该测试。病例分为原发性或继发性脊柱侧弯。收集每名患者的人口统计学数据、术前气道压、COBB角度、术中同种异体输血以及产生可接受肺功能测试结果的能力。在肺功能测试结果满意的患者中，收集用力肺活量和最大吸气压力。
结 果
研究样本包括433例患者，288例原发性脊柱侧弯，145例继发性脊柱侧弯。在原发性脊柱侧弯患者中，90%能够产生可接受的肺功能测试结果，0例术后仍插管，6例入院重症监护病房。在继发性脊柱侧弯患者中，44%不能进行肺功能测试。在那些尝试测试的人中，30%的人无法得出有意义的结果。用力肺活量和最大吸气压力与术后插管或重症监护病房入院无关。体重、术中输血、ASA分级、术前双侧气道正压与患者预后相关。在357例尝试肺功能测试的患者中，37例有高危结果。37例患者中只有1例术后仍留置气管插管。
结 论
后路脊柱融合的患者，尤其是继发性脊柱侧弯的患者，往往无法充分进行肺功能测试。在肺功能测试的患者中，结果与术后插管或重症监护病房入院之间没有关联。所有脊柱侧弯患者的常规肺功能检测可不用于脊柱后融合前的风险评估。临床医生应该考虑一种有针对性的方法，将肺功能测试的范围限制在此类患者身上，因为其结果可以指导医师术前的治疗方案更优化，这可能会改善患者预后结果，减少无效治疗和治疗成本。
原始文献摘要
Nicholas E. Burjek,et al；Preoperative Pulmonary Function Test Results Are Not Associated With Postoperative Intubation in Children Undergoing Posterior Spinal Fusion for Scoliosis: A Retrospective Observational Study.[J] Anesth Analg.2019; 129:184–91
BACKGROUND:
Preoperative pulmonary function tests are routinely obtained in children with scoliosis undergoing posterior spinal fusion despite unclear benefits as a perioperative risk assessment tool and frequent inability of patients to provide acceptable results. The goal of this study was to determine whether preoperative pulmonary function test results are associated with the need for postoperative intubation or intensive care unit admission after posterior spinal fusion.
Methed:
The electronic medical records of patients who underwent posterior spinal fusion at a pediatric tertiary hospital between June 2012 and August 2017 were reviewed. Pulmonary function tests were consistently ordered for all patients, unless the patient was deemed unable to perform the test due to cognitive disability. Cases were categorized as primary or secondary scoliosis. Demographic data, preoperative bilevel positive airway pressure use, Cobb angle, intraoperative allogeneic blood transfusion, and ability to produce acceptable pulmonary function test results were collected for each patient. In patients with satisfactory pulmonary function test results, forced vital capacity and maximum inspiratory pressure were collected. Primary outcomes for analysis were postoperative intubation and intensive care unit admission. Univariable logistic regression models were used to assess the association between each variable of interest and the primary outcomes.
Results：
The study sample included 433 patients, 288 with primary scoliosis and 145 withsecondary scoliosis. Among patients with primary scoliosis, 90% were able to produce acceptable pulmonary function test results, zero remained intubated postoperatively, and 6 were admitted to the intensive care unit. Among patients with secondary scoliosis, 44% could not attempt pulmonary function tests. Among those who did attempt the test, 30% were unable to produce meaningful results. Forced vital capacity and maximum inspiratory pressure were not found to be associated with postoperative intubation or intensive care unit admission. Weight,Cobb angle, intraoperative blood transfusion, American Society of Anesthesiologists physical status classification, and preoperative bilevel positive airway pressure use were associated with patient outcomes. Among 357 total patients who attempted pulmonary function tests, 37 had high-risk results. Only 1 of these 37 patients remained intubated postoperatively.
Conclusion:
Patients undergoing posterior spinal fusion, especially those with secondary scoliosis, are frequently unable to adequately perform pulmonary function tests. Among patients with interpretable pulmonary function tests, there was no association between results and postoperative intubation or intensive care unit admission. Routine pulmonary function testing for all patients with scoliosis may not be indicated for purposes of risk assessment before posterior spinal fusion. Clinicians should consider a targeted approach and limit pulmonary function tests to patients for whom results may guide preoperative optimization as this may improve outcomes and reduce inefficiencies and costs.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：唐剑 编辑：何幼芹 审校：王贵龙