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

doi:10.3969/j.issn.1671-167X.2017.05.012

摘要/Abstract

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。

关键词: 呼吸道感染, 麻醉, 全身, 儿童, 前瞻性研究

Abstract: Objective: To investigate the effects of the recent upper respiratory tract infections (URI) on the incidence of perioperative respiratory adverse events in children scheduled to undergo general anesthesia and elective surgery. Methods: In the study, 232 children undergoing general anesthesia with laryngeal mask airway (LMA) for elective ophthalmic surgeries at Peking University First Hospital, Beijing, China, from Nov. 1, 2015 to May 10, 2016 were enrolled. On the day of the surgery, the parents of the children were preoperatively asked to fill out a questionnaire regarding the baseline characteristics and medical history of the children, including gender, age, height, weight, history of URI within the last 2 weeks before anesthesia, history of premature, long-term passive smoking exposure, habitual sleep snoring, and history of asthma. In addition, all adverse respiratory events throughout the perioperative pe-riods (oxygen desaturation, cough, copious secretions, laryngospasm and bronchospasm) as well as peri-operative variables (number of attempts to insert the LMA successfully, anesthesia duration and so on) were recorded. Multivariate Logistic regression analysis was applied to identify independent risk factors of perioperative respiratory adverse events. Results: Among the 232 children included in the study, 28.0% (65/232) presented with a history of a recent URI within the last 2 weeks before anesthesia. The pre-sence of the recent URI increased the incidence of oxygen desaturation (23.1% vs.12.0%, P=0.034), copious secretions (15.4% vs. 6.6%, P=0.036) and any of all the adverse respiratory events (32.3% vs. 18.6%, P=0.024). Multivariate Logistic regression analysis identified two independent risk factors of perioperative adverse respiratory events: a history of URI within the last 2 weeks before general anesthesia (OR=2.021, 95%CI: 1.023-3.994, P=0.043) and habitual sleep snoring (OR=3.660, 95%CI: 1.517-8.832, P=0.004). Conclusion: A history of a recent URI within 2 weeks before general anesthesia was associated with a higher incidence of oxygen desaturation, copious secretions and the overall respiratory adverse events. For the children with recent URI, we recommend the general anesthesia and elective surgery should be postponed for at least 2 weeks after the URI.

Key words: Respiratory tract infections, Anesthesia, general, Child, Prospective studies

中图分类号:

R726.1

李纯青, 王东信, 程彤, 郑雪宜. 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[J]. 北京大学学报(医学版), 2017, 49(5): 814-818.

LI Chun-qing, WANG Dong-xin, CHENG Tong, ZHENG Xue-yi. Effects of recent upper respiratory-tract infections on incidence of the perioperative respiratory adverse events in children: a prospective cohort study[J]. Journal of Peking University(Health Sciences), 2017, 49(5): 814-818.

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