合并轻中度上呼吸道感染患儿全身麻醉后呼吸系统并发症风险及评估  

Risk and assessment of respiratory complications after general anesthesia in children combined with mild or moderate upper respiratory tract infection

作　　者：唐春春[1] 任娟娟[1] 王义[1] 李娟[1] 张超[1] 朱昭琼[1] 

机构地区：[1]遵义医学院附属医院麻醉科贵州省麻醉与器官保护基础研究重点实验室,贵州遵义563003

出　　处：《中国妇幼保健》2015年第16期2534-2537,共4页Maternal and Child Health Care of China

基　　金：贵州省科技厅资助项目(黔科合SY字[2013]3064号)

摘　　要：目的：评估择期开腹和四肢手术合并近期轻中度上呼吸道感染（URI）患儿全身麻醉后呼吸系统并发症发生情况及其严重程度。方法：294例ASAⅠ-Ⅲ级择期行气管插管全麻开腹和四肢手术患儿,年龄20天～15岁,根据术前上感症状和体征,归为非URI组（un URI）、轻度URI组（mi URI）、中度URI组（mo URI）共3组。分别于手术期、手术后1天评估呼吸系统相关并发症发生率。结果：手术期多痰、咳嗽、Sp O2、舌后坠、喉痉挛、支气管痉挛、体温（T≥38℃）组间比较均无统计学差异（P〉0.05）;与un URI组相比,mo URI组屏气发生率增高（P〈0.05）。手术后Sp O2、屏气、舌后坠、喉痉挛、支气管痉挛、体温（T≥38℃）组间比较均无统计学差异（P〉0.05）;与un URI组相比,mo URI组咳嗽、多痰发生率增高（P〈0.05）;与mi URI组比,mo URI组咳嗽发生率增高（P〈0.05）。结论：合并轻度URI患儿行择期气管插管全麻开腹和四肢手术相对安全,而合并中度URI患儿并发症增加,建议全面评估风险利益关系后慎重实施全身麻醉,以防止严重意外发生。Objective： To evaluate the occurrence and severity of respiratory complications after general anesthesia for elective lap- arotomy and limbs operation in children combined with mild or moderate upper respiratory tract infection （URI） . Methods： A total of 294 children of ASA I -III undergoing tracheal intubation anesthesia for elective laparotomy and limbs operation, aged 20 days to 15 years, were divided into non-URI group, mild URI group, and moderate URI group according to preoperative symptoms and signs of URI. The incidence rates of respiratory related complications were assessed during operation and at one day after operation. Results： There was no statistically significant difference in profuse sputum, cough, SpO2, glossocoma, laryngospasm, bronchospasm, and temperature （38℃ or more than 38℃ ） during operation among the three groups （P〉0. 05 ） ; compared with non-URI group, the incidence rate of holding breath in moderate URI group increased significantly （P〈0. 05） After operation, there was no statistically significant difference in SpOt, holding breath, glossocoma, laryngospasm, bronchospasm, and temperature （38℃ or more than 38℃ ） among the three groups （P〉0. 05） ; compared with non-URI group, the incidence rates of cough and profuse sputum increased significantly （P〈0. 05 ） ; compared with mild URI group, the in- cidence rate of cough increased significantly （ P〈O. 05 ） . Conclusion： It is relatively safe to implement elective laparotomy and hmbs oper- ation among the children combined with mild URI under tracheal intubation anesthesia. But the respiratory complications in children with moderate URI increase. To prevent serious accident, it is suggested that the comprehensive assessment of the risk and benefits should be made before careful implementation of general anesthesia.

关 键 词：儿童 全身麻醉 上呼吸道感染 呼吸系统并发症 

分 类 号：R614.2[医药卫生—麻醉学]