| OBJECTIVE: Retrospective analysis was performed on children undergoing laparoscopic day surgery in the past three years,including: preoperative conventional ECG diagnosis results,intraoperative and postoperative ECG specific findings,and major intraoperative and postoperative cardiac adverse events.The perioperative electrocardiogram(ECG)of children was compared and analyzed to evaluate the value of perioperative ECG in pediatric laparoscopic day surgery.Methods: The clinical data of 566 children in the study group who completed preoperative routine ECG examination and 432 children in the control group who did not complete preoperative routine ECG examination from 2017 to2020 were analyzed statistically.Content includes: name,age,growth and development status(BMI),gender,hospitalization and basic data,the hospital diagnosis,preoperative routine electrocardiogram diagnosis and intraoperative and postoperative period ECG findings,major adverse cardiac events happening,some abnormal electrocardiogram diagnosis preoperatively with preoperative electrolyte and myocardial enzymology,etc.Results:1.Basic information of the two groups 1.1 There were 566 children in the study group(444 males,78.45%;122 females,21.55%);The control group had432 children(360 males,83.33%;72 females,16.67%);There was no difference in the number composition between the two groups.1.2 In the study group,there were 320 children with indirect inguinal hernia(56.54%),118 children with hydrocele(20.85%),and 128 children with cryptorchidism(22.61%);The control group included 248 children with indirect inguinal hernia(57.40%),78 children with hydrocele(18.06%)and 106 children with cryptorchidism(24.54%).There was no difference in the number composition of different diseases between the two groups.1.3 In the study group,there were280 cases(49.47%)aged from 5 to 7 years old,194 cases(34.28%)aged from 7to 10 years old,and 92 cases(16.25%)aged from 10 to 14 years old.In the control group,432 cases(100.00%)were aged 3-5 years.1.4 There was no significant difference in the intraoperative basic data between the study group and the control group.2.Statistical results of preoperative ECG diagnosis in the study group 2.1In research group,566 cases of children with 320 cases in preoperative diagnosis of abnormal electrocardiogram,and specific abnormal results: 270 items of sinus arrhythmia,47 items of sinus tachycardia,4 items of occasional ventricular premature beat,4 items of incomplete right bundle branch block,2items of occasional room premature beat,2 items of sinoatrial node wandering rhythm of the heart,2 items of WPW pre-excitation syndrome(type A),1 item of WPW pre-excitation syndrome(type B),1 item of sinus bradycardia.A total of 333 items,including 13 cases with abnormal ECG two results.Of the 320 cases,239 had completed the electrolyte and myocardial enzymology examination before surgery,and all the indexes were within the normal range.2.2 The composition ratio of preoperative ECG diagnosis results of the children with different diseases,ages and genders was consistent(P > 0.05).3.The study team intraoperative and postoperative period of ECG diagnosis statistics 3.1 Normal preoperative ECG diagnosis results of 65 cases in intraoperative and postoperative period appeared abnormal diagnosis,the results are as follows: 48 items of sinus tachycardia,5 items of occasional ventricular premature beat,5 items of sinus arrhythmia,4 items of occasional room premature beat,2 items of sinus bradycardia,1 item of once atrioventricular block.Preoperative abnormal electrocardiogram diagnosis results of 309 cases in intraoperative and postoperative period appeared abnormal ECG diagnosis,412 abnormal results are as follows: 276 items of sinus arrhythmia,105 items of sinus tachycardia,10 items of occasional ventricular premature beat,6 items of occasional room premature beat,4 items of incomplete right bundle branch block,4 item of sinus bradycardia,2 items of sinoatrial node wandering rhythm of the heart,2 items of WPW pre-excitation syndrome(type A),2 items of once atrioventricular block,1 item of WPW pre-excitation syndrome(type B).3.2 In the study group,the ECG diagnosis results of each subgroup were consistent during and after operation(P > 0.05).3.3 Comparison between the types of abnormal ECG during and after operation and the types of abnormal ECG before operation in the study group showed that sinus arrhythmia and sinus tachycardia were the main causes in both groups.However,statistical analysis showed that the two groups still had overall differences(P < 0.001),and sinus tachycardia significantly increased in the items of intraoperative and postoperative ECG abnormalities,while other types did not significantly increase.3.4 The comparison between the abnormal type of ECG in normal children during and after operation and the overall type of ECG in the study group before operation showed that sinus arrhythmia and sinus tachycardia were the main causes in both of them.However,statistical analysis showed that there were still differences between the two groups(P <0.001).Sinus arrhythmia was the main cause of ECG abnormality before surgery,while sinus tachycardia was the main cause of ECG abnormality during and after surgery in children with normal ECG.3.5 The comparison between the abnormal type of ECG during and after operation of the children with abnormal preoperative diagnosis and the overall type of ECG in the study group before operation showed that sinus arrhythmia was the main cause in both of them.However,there was still an overall difference between the two(P< 0.05).The sinus tachycardia increased significantly in the items of intraoperative and postoperative ECG abnormalities,while the increase of other types was not significant.4.The control team intraoperative and postoperative period of ECG diagnosis statistics 4.1 In the control group with 432 cases,345 cases in intraoperative and postoperative period with abnormal ECG diagnosis,some children with two or more abnormal,a total of 375 abnormal results,specific as follows: 202 items of sinus arrhythmia,159 items of sinus tachycardia,4 items of occasional ventricular premature beat,3 items of occasional room premature beat,2 items of sinus bradycardia,1 item of sinoatrial node wandering rhythm of the heart,1 item of WPW pre-excitation syndrome(type A),1 item of once atrioventricular block,1 item of WPW pre-excitation syndrome(type B),1 item of incomplete right bundle branch block.4.2 In the control group,the ECG of children in different gender groups and different disease groups was basically the same during and after operation(P > 0.05).5.Study group and control group intraoperative and postoperative electrocardiogram performance comparison analysis The proportion of abnormal ECG diagnosis results in the control group was higher than that in the study group(P < 0.01).Pair comparison analysis using Bonferroni method showed that only the proportion of sinus tachycardia was different,and the proportion in the control group was higher than that in the study group.No significant difference was found in the types of other abnormal diagnosis results.6.Statistics of major adverse cardiac events during and after operation No major cardiac adverse events occurred during or after laparoscopic day surgery in 998 children in the study group and control group.Conclusion: 1.According to the ASA-PS class system assessment for Ⅰ or Ⅱand no ambulatory surgery patients of cardiopulmonary disease,preoperative ECG abnormal rate is still high,the diagnosis of abnormal ECG types is rich,with sinus arrhythmia and sinus tachycardia is most common.2.The application of intraoperative and postoperative ECG monitoring in children undergoing laparoscopic day surgery can capture more abnormal ECG information than single preoperative conventional ECG,which can timely reflect the influence of anesthesia and surgical operation stimulation on the ECG activities of children undergoing laparoscopic surgery,and has a strong application necessity.3.Preoperative ECG can detect a high proportion of asymptomatic arrhythmias,but it has little value in predicting major adverse cardiac events during and after surgery. |
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