本文選題：呼吸 + 異物��； 參考：《上海醫(yī)學(xué)》2014年04期

【摘要】：目的分析小兒氣道異物取出術(shù)圍術(shù)期并發(fā)癥發(fā)生的危險因素。方法回顧性分析復(fù)旦大學(xué)附屬眼耳鼻喉科醫(yī)院自2012年3月—2013年3月在全身麻醉下行氣道異物取出術(shù)的7歲以下患兒的臨床資料,根據(jù)圍術(shù)期是否發(fā)生并發(fā)癥分入并發(fā)癥組和無并發(fā)癥組。比較兩組患兒性別、年齡、體重、異物類型、異物存留時間、癥狀、術(shù)前影像學(xué)表現(xiàn)、異物位置、手術(shù)時間和麻醉方式等的情況,采用多因素Logistic回歸分析臨床各項因素與圍術(shù)期并發(fā)癥的關(guān)系。結(jié)果共280例患兒于全身麻醉下行氣道異物取出術(shù),圍術(shù)期并發(fā)癥發(fā)生率為11.1%(31/280)。并發(fā)癥組31例,無并發(fā)癥組249例。兩組間患者的性別構(gòu)成、年齡、體重、異物存留時間、手術(shù)時間的差異均無統(tǒng)計學(xué)意義(P值均0.05)。有2項和2項術(shù)前癥狀的患者圍術(shù)期并發(fā)癥發(fā)生率分別為18.3%(23/126)和13.8%(4/29),均顯著高于有1項術(shù)前癥狀者的3.2%(4/125,P值均0.05);有1項和≥2項術(shù)前肺部影像學(xué)表現(xiàn)的患者圍術(shù)期并發(fā)癥發(fā)生率分別為10.0%(12/120)和16.8%(18/107),均顯著高于無術(shù)前肺部影像學(xué)表現(xiàn)者的1.9%(1/53,P值均0.05);麻醉通氣方式中,保留自主呼吸的患者的圍術(shù)期并發(fā)癥發(fā)生率為25.0%(11/44),顯著高于經(jīng)ManujetⅢ手動控制噴射通氣者的7.0%(14/199)和經(jīng)硬支氣管鏡側(cè)孔手動控制通氣者的16.2%(6/37,P值均0.05)。多因素Logistic回歸分析顯示,圍術(shù)期并發(fā)癥的發(fā)生與術(shù)前肺部影像學(xué)表現(xiàn)(OR=2.045,95%CI為1.129~3.706)和麻醉通氣方式(OR=1.964,95%CI為1.263~3.054)有關(guān)(P值均0.05)。結(jié)論術(shù)前影像學(xué)表現(xiàn)異常和自主呼吸通氣方式是小兒氣道異物取出術(shù)圍術(shù)期發(fā)生并發(fā)癥的危險因素。
[Abstract]:Objective to analyze the risk factors of perioperative complications in children's airway foreign body removal. Methods the clinical data of children under 7 years old in Otolaryngological Hospital Affiliated to Fudan University from March 2012 to March 2013 under general anesthesia were analyzed, and the complications were divided into complications group according to the complications during the perioperative period. The sex, age, weight, body weight, foreign body type, foreign body retention time, symptoms, preoperative imaging, foreign body position, operation time and mode of anesthesia were compared between the two groups. The relationship between the clinical factors and perioperative complications was analyzed by multiple factor Logistic regression. The results of 280 children were under general anesthesia. The incidence of perioperative complications was 11.1% (31/280). There were 31 cases in complication group and 249 cases without complication. There was no significant difference in sex composition, age, weight, foreign body retention time, and operation time (P value 0.05). 2 and 2 preoperative symptoms were 18, respectively, and the incidence of complications was 18, respectively. .3% (23/126) and 13.8% (4/29) were significantly higher than 3.2% (4/125, P, 0.05) with 1 preoperative symptoms, 1 and 2 preoperative pulmonary imaging findings were 10% (12/120) and 16.8% (18/107), respectively, which were significantly higher than 1.9% (1/53, P, 0.05) without preoperative pulmonary imaging. The incidence of perioperative complications in patients with spontaneous breathing was 25% (11/44), significantly higher than 16.2% (6/37, P, 0.05) of 7% (14/199) and manual controlled ventilation by Manujet III manual control. Multiple factor Logistic regression analysis showed that perioperative complications were associated with pre operation lung. The imaging findings (OR=2.045,95%CI 1.129~3.706) and anesthesia ventilation (OR=1.964,95%CI 1.263~3.054) were related (P value was 0.05). Conclusion the preoperative imaging abnormalities and autonomous respiratory ventilation were the risk factors for the perioperative complications in children's airway foreign body removal.
【作者單位】： 復(fù)旦大學(xué)附屬眼耳鼻喉科醫(yī)院麻醉科;
【分類號】：R768.4

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本文編號：2010872