【原】【罂粟摘要】伴有阻塞性睡眠呼吸暂停的高危患儿行腺样体扁桃体切除术后的呼吸道并发症：一项回顾性队列研究

伴有阻塞性睡眠呼吸暂停的高危患儿行腺样体扁桃体切除术后的呼吸道并发症：一项回顾性队列研究

贵州医科大学 麻醉与心脏电生理课题组

翻译：马艳燕 编辑：张中伟 审校：曹莹

背景

    阻塞性睡眠呼吸暂停（OSA）在儿童中的发病率为1%-4%；腺样体扁桃体切除术是一种有效的治疗方法。在患儿中，腺样体扁桃体切除术中死亡/重型颅脑损伤的发生率为0.6/10000，60%是继发于呼吸道/呼吸事件。早期研究发现，年龄小于2岁，严重肥胖，伴有颅面部、神经肌肉、心脏/呼吸系统疾病或严重阻塞性睡眠呼吸暂停(OSA)的患儿术后发生呼吸道不良事件(AE)的风险很高。

       首先，我们的目标是调查与患儿在 PACU、PICU发生术后呼吸道不良事件有关的危险因素。其次，我们调查了术后在PACU无不良事件的情况下在PICU 发生呼吸道不良事件的相关因素，以预测术后在PACU观察的患儿入PICU期间的注意事项。

方法

      2006年8月至2015年9月期间实施腺样体扁桃体切除术后入PICU的患儿行回顾性研究。记录人口统计资料、危险因素和术后呼吸道不良事件发生情况(血氧饱和度<92%、喘鸣、支气管痉挛、肺炎、肺水肿、再次插管)。

结果

   在研究期间，3997名患儿接受了4029例扁桃体/腺样体手术。179例术后入PICU，符合纳入标准。PICU术后呼吸道不良事件的发生率为59%，在任何特定风险类别中为44%-83%。PACU术后呼吸道不良事件发生率为42%。在PACU发生呼吸道不良事件的患儿中，92%的患儿在PICU发生了呼吸道不良事件；然而，在PACU没有发生呼吸道不良事件的患儿中，仍有35%的患儿在PICU发生了呼吸道不良事件。

结论

   在接受腺样体扁桃体切除术的高危患儿中，观察在PACU期间2小时内没有不良事件并不能预测随后在PICU中没有呼吸道不良事件。

原始文献来源

   Ekstein M, Zac L, Schvartz R. Respiratory complications after adenotonsillectomy in high-risk children with obstructive sleep apnea: A retrospective cohort study. Acta Anaesthesiol Scand. 2020 Mar;64(3):292-300.

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Respiratory complications after adenotonsillectomy in high‐risk

children with obstructive sleep apnea: A retrospective cohort

study

Abstractive

Background: Obstructive sleep apnea (OSA) occurs in 1%‐4% of children; adenotonsillectomy is an effective treatment. Mortality/severe brain injury occurs among 0.6/10 000 adenotonsillectomies; in children, 60% are secondary to airway/respiratory events. Earlier studies identified that children aged <2 years, extremes of weight, with comorbidities of craniofacial, neuromuscular, cardiac/respiratory disease, or severe OSA are at high risk for adverse post‐operative respiratory events (AE).We aimed to: Firstly, investigate which risk factors were associated with AEs either in the post‐anesthesia care unit (PACU), pediatric intensive care unit (PICU), or both in this population. Secondly, we investigated factors associated with post‐operative PICU AE despite no event in the PACU in order to predict need of post‐operative PICU after their PACU stay.

Methods: Retrospective study of children admitted to the PICU after adenotonsillectomy between 08/2006‐09/2015. Demographics, risk factors, and occurrence of AE (oxygen saturation <92, stridor, bronchospasm, pneumonia, pulmonary edema, re‐intubation) were recorded.

Results: During the studied time period 4029 tonsil/adenoid procedures were performed in 3997 children. 179, admitted to the PICU post‐operatively, met criteria for analysis. PICU AEs occurred in 59%: 44%‐83% in any particular risk category. PACU AEs occurred in 42%. Of those with PACU events: 92% suffered AEs in the PICU; however, 35% of those without a PACU AE still suffered a PICU AE.

Conclusion: Among high‐risk children undergoing TA, absence of adverse events in PACU during a 2‐hour observation period does not predict absence of subsequent AEs in the PICU.

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