【摘要】：[目的]:通過對唇裂患兒氣管插管前預防性靜脈注射地塞米松,比較拔管后喉頭水腫的發(fā)生情況,評估靜脈注射地塞米松對預防唇裂患兒拔管后喉頭水腫的療效,探討其作用機制,為其在臨床的進一步推廣及使用提供理論和實踐依據(jù)。[方法]:收集2013年1月-2016年11月在昆明醫(yī)科大學第四附屬醫(yī)院麻醉科進行全身麻醉機械通氣的唇裂患兒140例作為研究對象,所有患兒均行經(jīng)口氣管插管術(shù)。將其分為觀察組和對照組,觀察組70例患兒術(shù)前靜脈注射地塞米松,對照組70例患兒做為空白對照。所有研究對象中男性患兒92例,占65.7%,女性患兒48例,占34.3%。所有氣管插管操作均由主治及主治以上醫(yī)師進行。拔管后密切觀察患兒呼吸功能變化,若出現(xiàn)喉頭水腫,根據(jù)水腫程度,給予脫水利尿處理,心要時急行氣管插管或氣管切開。分別記錄兩組患兒喉頭水腫發(fā)生例數(shù)及水腫程度,所有數(shù)據(jù)應(yīng)用SPSS20.0版本(IBMSPSSStatistics20.0)統(tǒng)計軟件進行處理,計量資料采用正態(tài)性檢驗,正態(tài)分布資料以形式記錄,組間比較采用t檢驗或方差分析,非正態(tài)分布資料以Me(25th-75th%)形式記錄,組間比較采用秩和檢驗;計數(shù)資料以例數(shù)形式記錄,組間比較采用χ2檢驗,P0.05為差異有顯著性。[結(jié)果]:觀察組的70例患兒中,4例發(fā)生喉頭水腫,發(fā)生率為5.7%;對照組的70例患兒中,6例發(fā)生喉頭水腫,發(fā)生率為8.6%。兩組患兒喉頭水腫發(fā)生率經(jīng)Fisher確切概率法檢驗,差異無統(tǒng)計學意義(P= 0.745)。[結(jié)論]:對行機械通氣全身麻醉唇裂患兒,預防性使用地塞米松不能降低拔管后喉頭水腫的發(fā)生率,因此不推薦臨床用于預防喉頭水腫。
[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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R726.1

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