近期上呼吸道感染史对儿童围术期呼吸系统不良事件的影响:前瞻性队列研究

发布时间：2018-01-19 04:17

本文关键词： 呼吸道感染麻醉全身儿童前瞻性研究　出处：《北京大学学报(医学版)》2017年05期 　论文类型：期刊论文

【摘要】：目的:观察近期上呼吸道感染史对接受全身麻醉的儿童围术期呼吸系统不良事件风险的影响。方法:选择2015年11月至2016年5月期间在北京大学第一医院接受全身麻醉下眼科择期手术的232例儿童,术前通过儿童父母填写问卷的形式采集并记录儿童的术前基础资料及相关疾病史,包括性别、年龄、身高、体重、术前2周内有无上呼吸道感染史、有无早产史、长期被动吸烟史、经常性夜间打鼾史和哮喘病史。同时记录围术期相关信息(喉罩成功置入所需的次数、麻醉时间等),观察围术期出现的呼吸不良事件,包括氧饱和度下降、气道分泌物增加、咳嗽、喉痉挛、支气管痉挛的发生情况。应用多因素Logistic回归模型筛选儿童全身麻醉围术期呼吸系统不良事件的危险因素。结果:入选的232例儿童中,术前2周内有上呼吸道感染史的占28.0%(65/232),其全身麻醉苏醒期发生氧饱和度降低(23.1%vs.12.0%,P=0.034)、气道分泌物增加(15.4%vs.6.6%,P=0.036)或一种及以上呼吸系统不良事件(32.3%vs.18.6%,P=0.024)的风险增加。多因素Logistic回归分析显示,术前2周内的上呼吸道感染史(OR=2.021,95%CI:1.023~3.994,P=0.043)和经常性夜间打鼾史(OR=3.660,95%CI:1.517~8.832,P=0.004)是儿童围术期呼吸系统不良事件的独立危险因素。结论:术前2周内的上呼吸道感染史伴随儿童围术期呼吸系统不良事件的风险增加。
[Abstract]:Objective: to observe the effect of recent history of upper respiratory tract infection on perioperative adverse respiratory events in children undergoing general anesthesia. From November 2015 to May 2016, 232 children undergoing elective ophthalmic surgery under general anesthesia in the first Hospital of Peking University were selected. The basic data and related disease history of children were collected and recorded by the form of parents' questionnaire before operation, including gender, age, height, weight, history of upper respiratory tract infection within 2 weeks before operation. History of preterm labor, long-term passive smoking, frequent nocturnal snoring and asthma. Information about perioperative period (number of successful placement of laryngeal mask, duration of anesthesia, etc.) was recorded. Observe perioperative respiratory adverse events, including decreased oxygen saturation, increased airway secretions, cough, and laryngeal spasm. The incidence of bronchiospasm. The risk factors of respiratory adverse events in children during general anesthesia were screened by multivariate Logistic regression model. Results: 232 children were enrolled. The patients with upper respiratory tract infection within 2 weeks before operation had a history of upper respiratory tract infection (28.0%, 65 / 232A), and the oxygen saturation decreased 23.1vs.12.0 during the general anesthesia recovery period (P = 0.034). Airway secretions increased by 15.4vs.6.6cm (0.036) or one or more adverse events of respiratory system (32.3vs.18.6%). Multivariate Logistic regression analysis showed that the history of upper respiratory tract infection within 2 weeks before operation was OR2.021. I have a regular nocturnal snoring history of 3.660 and 95 CI: 1.517 and 8.832. Conclusion: the history of upper respiratory tract infection within 2 weeks before operation increases the risk of perioperative respiratory adverse events in children.
【作者单位】：北京大学第一医院麻醉科;
【分类号】：R726.1
【正文快照】： 儿童的呼吸系统较成人具有显著不同的解剖结构和生理特点,发生围术期呼吸系统不良事件的风险远高于成人[1]。当儿童合并活动性上呼吸道感染(upper respiratory tract infections,URI)时发生围术期呼吸不良事件的风险将明显增加[2-10]。URI症状消失后数周内,由于病毒感染导致的

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