本文由小咖机器人翻译整理

期刊来源：Lancet

原文链接：https://doi.org/10.1016/S0140-6736(24)00103-X

摘要内容如下：

背景

安全的麻醉和手术是公共卫生的当务之急。很少有数据描述非洲儿童接受麻醉和手术的结果。我们的目的是获得可靠的流行病学数据，以描述在非洲医院接受麻醉和手术的儿童的患者护理和结果。

方法

本研究是一项为期14天的国际前瞻性观察性队列研究，研究对象为非洲接受手术的儿童（年龄<18岁）。我们招募了尽可能多的提供手术治疗的各级医院（一级、二级和三级）。各医院招募所有符合条件的儿童，为期14天，从各参与医院在研究招募期间（2022年1月15日至12月23日）选择的日期开始。前瞻性地收集纸质病例记录表中连续患者的数据。主要结果是手术后30天内的住院并发症，次要结果是手术后30天内的住院死亡率。我们还收集了描述可用设备、设施和协议的医院级数据。该研究已在ClinicalTrials.gov（NCT05061407）注册。

调查结果

我们从31个非洲国家的249家医院招募了8625名儿童。平均年龄为6.1（SD 4.9）岁，8600名儿童中有5675名（66.0%）为男性。大多数儿童（8579例患者中的6110例[71.2%]）属于美国麻醉医师学会身体状况评分1类，接受择期手术（8604例患者中的5325例[61.9%]）。8515名儿童中有1532名（18.0%）发生了术后并发症，主要是感染（8538名儿童中有971名[11.4%]）。8596例患者中有199例（2.3%）死亡，199例患者中有169例（84.9%）在急诊手术后死亡。在1530例并发症中，166例（10.8%）因术后并发症死亡。据报告，手术室对新生儿（223家医院中的121家[54.3%]）、婴儿（223家医院中的147家[65.9%]）和6岁以下儿童（223家医院中的188家[84.3%]）的麻醉和手术是安全的。

解释

非洲儿童麻醉和手术后的结果很差，在未经调整的粗略比较中，并发症发生率高达高收入国家的4倍（18%vs 4.4-14%），死亡率高达高收入国家的11倍（每1000名儿童中23.15例死亡vs 2.18例死亡）。为了改善非洲儿童的手术结果，我们需要加强卫生系统，为麻醉和手术提供安全的环境，并制定解决高抢救失败率的战略。

英文原文如下：

Abstracts

BACKGROUND  Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anaesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anaesthesia and surgery in hospitals in Africa.

METHODS  This study was a 14-day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14-day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in-hospital postoperative complications within 30 days of surgery and the secondary outcome was in-hospital mortality within 30 days after surgery. We also collected hospital-level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407.

FINDINGS  We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals).

INTERPRETATION  Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4-14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 deaths per 1000 children). To improve surgical outcomes for children in Africa, we need health system strengthening, provision of safe environments for anaesthesia and surgery, and strategies to address the high rate of failure to rescue.

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