前纵隔肿瘤患儿的临床特征及麻醉期间发生通气困难的危险因素分析  

Analysis of the clinical characteristics of children with anterior mediastinal tumors and risk factors of dyspnea during anesthesia

作　　者：刘婷婷 戴丹 LIU Tingting;DAI Dan(Department of Anesthesiology,the Children’s Hospital Zhejiang University School of Medicine,Hangzhou 310051,Zhejiang,China)

机构地区：[1]浙江大学医学院附属儿童医院麻醉科,杭州310051

出　　处：《癌症进展》2022年第5期486-489,共4页Oncology Progress

摘　　要：目的 探讨前纵隔肿瘤患儿的临床特征及麻醉期间发生通气困难的危险因素。方法 根据手术麻醉期间是否发生通气困难将80例前纵隔肿瘤患儿分为通气困难组(n=30)和非通气困难组(n=50),记录两组患儿的临床特征,患儿麻醉期间发生通气困难的危险因素采用单因素分析及多因素Logistic回归分析,采用受试者工作特征(ROC)曲线分析独立危险因素对麻醉期间通气困难的预测价值。结果 通气困难组患儿的肿瘤直径明显大于非通气困难组患儿,差异有统计学意义(P﹤0.01);通气困难组患儿喘鸣、呼吸困难的发生率均高于非通气困难组患儿,差异均有统计学意义(P﹤0.05)。通气困难组中术前存在适应性体位、肺部及胸腔内感染、心血管受压、主气管受压的患儿比例均高于非通气困难组,差异均有统计学意义(P﹤0.05)。单因素及多因素分析结果显示,肿瘤直径大、呼吸困难、术前存在适应性体位、心血管受压、主气管受压均是前纵隔肿瘤患儿麻醉期间发生通气困难的独立危险因素(P﹤0.05)。ROC曲线分析结果显示,术前存在适应性体位、主气管受压预测麻醉期间发生通气困难的灵敏度最高(100%),存在主气管受压预测麻醉期间发生通气困难的特异度最高(97.87%)。结论 前纵隔肿瘤患儿以淋巴瘤为主,并且多伴随咳嗽等症状,术前存在适应性体位、主气管受压均是前纵隔肿瘤患儿麻醉期间发生通气困难的独立危险因素,且可有效预测通气困难的发生。Objective To investigate the clinical characteristics of children with anterior mediastinal tumors and the risk factors of dyspnea during anesthesia. Method A total of 80 children with anterior mediastinal tumors were divided into dyspnea group(n=30) and non-dyspnea group(n=50) according to whether dyspnea occurred during surgical anesthesia. The clinical characteristics of children with anterior mediastinal tumors in the two groups were recorded. The risk factors of dyspnea during anesthesia were analyzed by univariate analysis and multivariate Logistic regression analysis, and the predictive value of risk factors for dyspnea during anesthesia was analyzed by receiver operating characteristic(ROC)curve. Result The tumor diameter in the dyspnea group was larger than that in the non-dyspnea group(P<0.01). The incidence of stridor and dyspnea in the dyspnea group were higher than those in the non-dyspnea group(P<0.05). The proportion of children with preoperative adaptive posture, pulmonary and thoracic infection, cardiovascular compression and main trachea compression in the dyspnea group were higher than those in the non-dyspnea group(P<0.05). The results of univariate and multivariate analysis showed that large tumor diameter, dyspnea, preoperative adaptive posture, cardiovascular compression and main trachea compression were independent risk factors for dyspnea during anesthesia(P<0.05).The ROC curve showed that the sensitivity of preoperative adaptive posture and main trachea compression to predict dyspnea during anesthesia was the highest(100%), and the specificity of preoperative main trachea compression to predict dyspnea during anesthesia was the highest(97.87%). Conclusion Children with anterior mediastinal tumors are mainly lymphoma, accompanied by cough and other symptoms. Preoperative adaptive posture, main trachea compression are independent risk factors for dyspnea during anesthesia, and can effectively predict the occurrence of dyspnea.

关 键 词：前纵隔肿瘤 临床特征 麻醉期间 通气困难 危险因素 

分 类 号：R734.5[医药卫生—肿瘤]