新生儿非心脏手术后转入新生儿重症监护病房的围手术期相关因素

Perioperative factors associated with NICU admission after noncardiac surgery in neonates

摘要

目的 探讨术前未接受高级生命支持的新生儿非心脏手术后转入新生儿重症监护病房（NICU）的相关因素。方法 回顾性纳入2024年4月至2026年3月湖南省儿童医院接受气管插管全身麻醉非心脏手术的新生儿450例, 按术后去向分为NICU组41例和非NICU组409例, 比较两组围手术期资料, 并进行多因素二元Logistic回归分析。结果 转入NICU的发生率为9.1%（41/450）。多因素二元Logistic回归分析显示, 术时矫正胎龄与术后转入NICU呈负相关（每增加1周, OR=0.697）；美国麻醉医师协会（ASA）身体状况分级、术中低氧血症及麻醉时间与术后转入NICU呈正相关, 其中ASA分级每升高1级、发生术中低氧血症及麻醉时间每增加10 min的OR分别为3.700、2.946和1.164（均P<0.05）。结论 术后NICU去向与术前成熟度、总体病情及术中氧合和麻醉经过相关, 术毕可结合术前与术中信息重新评估监护级别和转运路径。

Abstract

Objective To identify factors associated with postoperative neonatal intensive care unit (NICU) admission in neonates without preoperative advanced life support. Methods We retrospectively included 450 neonates who underwent noncardiac surgery under general anesthesia with tracheal intubation at Hunan Children's Hospital from April 2024 to March 2026 and divided them into two groups based on where they were sent after surgery. Perioperative data were compared between the NICU group (n=41) and the non-NICU group (n=409). Multivariable binary Logistic regression analysis was performed. Results NICU admission occurred in 9.1% (41/450). Multivariable binary Logistic regression analysis showed that adjusted gestational age at surgery was negatively associated with NICU admission (OR=0.697 per week increased), whereas American Society of Anesthesiologists (ASA) physical status, intraoperative hypoxemia, and anesthesia duration were positively associated with NICU admission (OR=3.700 per grade increased for ASA grading, OR=2.946 per 10 min increased in intraoperative hypoxemia, and OR=1.164 per 10 min increased in anesthesia duration, respectively; all P<0.05). Conclusion Postoperative NICU admission is associated with preoperative maturity, overall disease condition, intraoperative oxygenation, and anesthesia duration. After surgery, the monitoring grade and transfer pathway may be reassessed based on the data before and during surgery.

关键词

新生儿 / 新生儿重症监护病房 / 非心脏手术 / 术时矫正胎龄 / 低氧血症

Key words

Neonate / Neonatal intensive care unit / Noncardiac surgery / Adjusted gestational age at surgery / Hypoxemia

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基金资助

湖南省自然科学基金项目(2024JJ9341)