静注地塞米松预防唇裂患儿拔管后喉头水肿的临床研究

发布时间：2018-10-10 16:01

【摘要】：[目的]:通过对唇裂患儿气管插管前预防性静脉注射地塞米松,比较拔管后喉头水肿的发生情况,评估静脉注射地塞米松对预防唇裂患儿拔管后喉头水肿的疗效,探讨其作用机制,为其在临床的进一步推广及使用提供理论和实践依据。[方法]:收集2013年1月-2016年11月在昆明医科大学第四附属医院麻醉科进行全身麻醉机械通气的唇裂患儿140例作为研究对象,所有患儿均行经口气管插管术。将其分为观察组和对照组,观察组70例患儿术前静脉注射地塞米松,对照组70例患儿做为空白对照。所有研究对象中男性患儿92例,占65.7%,女性患儿48例,占34.3%。所有气管插管操作均由主治及主治以上医师进行。拔管后密切观察患儿呼吸功能变化,若出现喉头水肿,根据水肿程度,给予脱水利尿处理,心要时急行气管插管或气管切开。分别记录两组患儿喉头水肿发生例数及水肿程度,所有数据应用SPSS20.0版本(IBMSPSSStatistics20.0)统计软件进行处理,计量资料采用正态性检验,正态分布资料以形式记录,组间比较采用t检验或方差分析,非正态分布资料以Me(25th-75th%)形式记录,组间比较采用秩和检验;计数资料以例数形式记录,组间比较采用χ2检验,P0.05为差异有显著性。[结果]:观察组的70例患儿中,4例发生喉头水肿,发生率为5.7%;对照组的70例患儿中,6例发生喉头水肿,发生率为8.6%。两组患儿喉头水肿发生率经Fisher确切概率法检验,差异无统计学意义(P= 0.745)。[结论]:对行机械通气全身麻醉唇裂患儿,预防性使用地塞米松不能降低拔管后喉头水肿的发生率,因此不推荐临床用于预防喉头水肿。
[Abstract]:[objective]: to evaluate the effect of intravenous dexamethasone on preventing laryngeal edema after extubation in children with cleft lip before tracheal intubation, and to evaluate the effect of intravenous dexamethasone on the prevention of laryngeal edema after extubation in children with cleft lip. In order to provide theoretical and practical basis for its further promotion and application in clinical practice, the mechanism of its action is discussed. [methods] 140 children with cleft lip undergoing mechanical ventilation under general anesthesia were collected from January 2013 to November 2016 in Department of Anesthesiology, fourth affiliated Hospital of Kunming Medical University. Dexamethasone was injected intravenously in the observation group (70 cases) and the control group (70 cases) as a blank control. There were 92 male children (65. 7%) and 48 female children (34. 3%). All tracheal intubation operations are performed by the main treatment and more than the doctor. The changes of respiratory function were observed closely after extubation. If laryngeal edema appeared, dehydration and diuresis should be given according to the degree of edema, and tracheal intubation or tracheotomy should be performed in heart. The occurrence and extent of laryngeal edema were recorded in two groups. All the data were processed by SPSS20.0 version (IBMSPSSStatistics20.0) statistical software, the measurement data were measured by normal test, and the data of normal distribution were recorded in the form of normal distribution data. T test or ANOVA was used in the comparison between groups, the non-normal distribution data was recorded in the form of Me (25th-75th%), the rank sum test was used in the inter-group comparison, and the counting data was recorded in the form of examples and 蠂 2 test among the groups, the difference was significant (P0.05). [results]: of the 70 children in the observation group, 4 cases developed laryngeal edema, the incidence was 5.7, and in the control group, 6 cases developed laryngeal edema (8.6%). There was no significant difference in laryngeal edema between the two groups by Fisher's exact probability method (P = 0.745). Conclusion: prophylactic use of dexamethasone can not reduce the incidence of laryngeal edema after extubation in children with cleft lip under general anesthesia under mechanical ventilation, so it is not recommended to be used clinically to prevent laryngeal edema.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.1

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