肌松药对新生儿先天性食管闭锁-气管食管瘘术后预后的影响

Effect of muscle relaxants on the prognosis of neonates with congenital esophageal atresia-tracheoesophageal fistula after surgery

摘要:

目的 总结先天性食管闭锁-气管食管瘘（esophageal atresia-tracheoesophageal fistula，EA-TEF）新生儿围手术期肌松药的应用经验。方法 回顾性纳入2017~2019年首都医科大学附属北京儿童医院新生儿中心58例初治EA-TEF新生儿的临床资料，比较术后肌松药应用不同时间组（≤ 5 d组和 > 5 d组）吻合口漏发生率的差异，以及术后肌松药应用时间与机械通气时间之间的相关性。结果 58例EA-TEF患儿中，44例接受手术治疗，其中35例EA-TEF Ⅲ型患儿行胸腔镜手术。该35例患儿中，30例（86%）术后应用肌松药；肌松药应用中位时间为4.75 d；6例（18%）发生吻合口漏。肌松药应用≤ 5 d组与 > 5 d组之间吻合口漏发生率的差异无统计学意义（P > 0.05）。术后有创机械通气时间与肌松药应用时间之间存在正相关性（r_s=0.548，P < 0.05）。结论 EA-TEF新生儿术后长时间应用肌松药不能明显减少吻合口漏的发生，反而可延长有创机械通气时间，因此不建议术后长时间应用肌松药物。

Abstract:

Objective To summarize the experience in the application of muscle relaxants in the perioperative period in neonates with congenital esophageal atresia-tracheoesophageal fistula (EA-TEF). Methods A retrospective analysis was performed on the medical data of 58 previously untreated neonates with EA-TEF who were treated in the Neonatal Center of Beijing Children's Hospital, Capital Medical University from 2017 to 2019. The incidence rate of anastomotic leak was compared between the neonates receiving muscle relaxants for different durations after surgery (≤ 5 days and > 5 days). The correlation between the duration of postoperative use of muscle relaxants and the duration of mechanical ventilation was evaluated. Results Among the 58 neonates with EA-TEF, 44 underwent surgery, among whom 35 with type III EA-TEF underwent thoracoscopic surgery. Among these 35 neonates, 30 (86%) received muscle relaxants after surgery, with a median duration of 4.75 days, and 6 (18%) experienced anastomotic leak. There was no significant difference in the incidence rate of anastomosis leak between the ≤ 5 days and > 5 days groups (P > 0.05). The duration of postoperative invasive mechanical ventilation was positively correlated with the duration of the use of muscle relaxants (rs=0.548, P < 0.05). Conclusions Prolonged use of muscle relaxants after surgery cannot significantly reduce the incidence of anastomotic leak, but can prolong the duration of invasive mechanical ventilation in neonates with EA-TEF. Therefore, prolonged use of muscle relaxants is not recommended after surgery.