心包积液患儿围术期不良事件的危险因素分析  

The risk factors associated with adverse events in pediatric pericardial effusion requiring general anesthesia for surgical intervention

作　　者：彭玲珑 杜敏[1] 郭冉[1] 刘光建[1] 徐颖[1] 

机构地区：[1]重庆医科大学附属儿童医院麻醉科重庆市儿童发育疾病研究教育部重点实验室重庆市儿科学重点实验室重庆市儿童发育重大疾病诊治与预防国际科技合作基地,400014

出　　处：《临床麻醉学杂志》2015年第4期368-371,共4页Journal of Clinical Anesthesiology

基　　金：国家临床重点专科建设项目(国卫办医函[2013]544)

摘　　要：目的 回顾性分析心包积液患儿围术期不良事件的影响因素.方法 我院2009年1月至2014年7月手术治疗的心包积液患儿157例,麻醉期间不良事件定义为诱导后出现低氧、低血压或心律失常.应用单因素和多因素Logistic回归分析不良事件的危险因素.结果 有38例（24.2％）患儿发生不良事件（A组）,其中一般不良事件31例（81.6％）,严重不良事件7例（18.4％）.A组术前合并胸腔积液、呼吸困难、奇脉、心房/心室压迫、较高ASA分级及入手术室时呼吸急促、心动过速、低氧、低血压明显多于无不良事件组（N组）（P＜0.05）.多因素Logistic回归分析显示,术前呼吸困难（OR=6.8,95％CI 1.4～12.4）、入手术室时低氧（OR=5.5,95％CI 1.1～15.9）、入手术室时低血压（OR=3.4,95％CI 1.2～9.1）及心房/心室压迫（OR=6.3,95％CI 1.8～22.1）是不良事件的独立危险因素.结论 对存在危险因素的心包积液患儿应警惕其麻醉期间发生不良事件.Objective To identify the risk factors associated with adverse events during general anesthesia in pediatric pericardial effusion surgery. Methods Medical records of 157 children for sur gical treatment under general anesthesia for pericardial effusion in Children＇s Hospital of Chongqing Medical University from January 2009 to July 2014 were collected and retrospectively analyzed. Univariate analysis and multivariate logistic regression analysis were used to investigate the risk factors of adverse events during general anesthesia. Results Overall adverse events rate was 24. 2% （38/157）, in which 31 （81.6%） suffered minor adverse events, and 7 （18.4%） suffered major adverse events during general anesthesia. For the univariate analysis, adverse events during general anesthesia associated with preoperative pleural effusion, dyspnea, pulsus paradoxus, atrial/ventricular collapse, the higher ASA anesthesia classification, and tachypnea, tachycardia, hypoxia, hypotension before anes- thesia induction （P〈0. 05）. Multivariate logistic regression analysis indicated that the risk factors of adverse events during anesthesia were preoperative dyspnea （OR： 6.8, 95%CI 1.4-12.4）, hypoxia （OR=5.5, 95 %CI 1.1-15.9） and hypotension （OR=3.4, 95%CI 1.2-9.1） before anesthesia induc- tion, and atrial/ventricular collapse （OR= 6.3, 95 % CI 1.8-22.1） on preoperative echocardiogram. Conclusion The risk factors associated with pediatric pericardial effusion surgery should alert the an- esthetist to the possibility of adverse events during general anesthesia.

关 键 词：心包积液 全身麻醉 小儿 不良事件 

分 类 号：R726.1[医药卫生—儿科]