小儿呼吸道异物术前发生急性呼吸功能不全的危险因素分析  

Risk factors of acute respiratory dysfunction in children with airway foreign body

作　　者：王素芳[1] 韩富根[1] 成怡冰[1] 僧东杰[1] 

机构地区：[1]郑州市儿童医院耳鼻咽喉科,450000

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第11期925-929,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 分析小儿呼吸道异物取出术前发生急性呼吸功能不全（acute respiratory dysfunction,ARD）的相关危险因素,为临床预防和治疗提供依据.方法 采用整群抽样的方法收集2009年7月至2012年12月456例呼吸道异物患儿临床资料,男246例,女210例;年龄0.5～11岁;发病到就诊时间0.15～14 d.记录患儿年龄、性别、既往史、异物史、异物种类、异物部位,是否合并发热、肺炎、纵隔或皮下积气等.监测患儿术前体温、呼吸频率、心率、紫绀情况,经皮氧饱和度（transcutaneous oxygen saturation）和（或）血气分析.对可能引起ARD发生的因素采用二分类进行单因素分析和多因素Logistic逐步回归分析.结果 78例（17.1％）异物取出术前发生ARD.456例患儿中455例一次手术成功,1例由气管镜手术转至胸外科开胸取出异物.452例患儿术后4～6h拔管撤机,ARD组有2例2～4d后拔管撤机,2例合并重症肺炎患儿死亡.经卡方检验发现,ARD组和非ARD组患几年龄,异物部位,体温,是否合并肺炎、纵隔或皮下积气是发生ARD的影响因素（P值均＜0.05）.多因素Logistic回归分析结果显示,异物位于主气管或双侧支气管、合并肺炎、合并纵隔或皮下积气是小儿呼吸道异物发生ARD的独立危险因素（P值均＜0.05）.结论 通过早期判断小儿呼吸道异物发生ARD的危险因素,可为临床进行手术及围手术期处理提供参考依据.Objective This study aims to analyze the independent risk factors of acute respiratory dysfunction （ARD） in children with airway foreign body and to assess possible prevention and treatment option in the future.Methods Clinical data of 456 cases of children with airway foreign body were retrospectively collected and analyzed by cluster sampling,including 246 males and 210 females,who received operation in our hospital between July,2009 and December,2012,aged 0.5-11 years old,onset to treatment time was 0.15-14 days.Chnical characteristics including age,gender,past medical history,time of onset,temperature,location of the foreign body,category of foreign bodies,complicated by pneumonia,complicated by subcutaneous and mediastinal emphysema were gathered.Temperature,respiratory rate,heart rate,cyanosis,transcutaneous oxygen saturation or arterial blood analysis were assayed before operation.Risk factors with statistical significance were screened with univariate logistic regression analysis,independent risk factors of ARD were determined with multivariate logistic regression analysis.Results Acute respiratory dysfunction occurred in 78 （17.1％） patients.The foreign bodies in 455cases were successfully removed brocboscopically in the first time.One case received chest surgery for foreign body removal.Total of 452 cases were successfully extubated and ventilator weaned 4-6 h after brochoscopy.In 2 cases,the ventilator was weaned 2-4 d after brochoscopy in ARD gup,and 2 cases with severe pneumonia died.Age,location of the foreign body,temperature,complicated by pneumonia,complicated by subcutaneous and mediastinal emphysema did not show significant difference between acute respiratory dysfunction group and non-acute respiratory dysfunction group （P ＜ 0.05）.Multivariate logistic regression analysis showed location of the foreign body and complicated by pneumonia,complicated by subcutaneous and mediastinal emphysema were independent risk factors for ARD.Conclusion Early judgement of the risk factors of acu

关 键 词：异物 气管疾病 儿童 呼吸功能不全 急性病 危险因素 

分 类 号：R768.4[医药卫生—耳鼻咽喉科]