患儿手术室外麻醉镇静相关不良事件分析  

Analysis of adverse events related to anesthesia and sedation outside the operating room in children

作　　者：黎国燕 陈昌浩 黄磊[1] 刘珅伶 浦艳英 彭晓晗[1] 许云波 谭昕 LI Guoyan;CHEN Changhao;HUANG Lei;LIU Shenling;PU Yanying;PENG Xiaohan;XU Yunbo;TAN Xin(Department of Sedative Analgesic Endoscopic Center,Kunming Children's Hospital,Kunming 650000,China)

机构地区：[1]昆明市儿童医院镇静镇痛腔镜中心,650000 [2]昆明医科大学第一附属医院麻醉科

出　　处：《临床麻醉学杂志》2023年第2期168-172,共5页Journal of Clinical Anesthesiology

摘　　要：目的分析患儿手术室外麻醉镇静相关不良事件的发生率、类型、分级及危险因素。方法回顾性分析2017年8月至2020年8月于镇静镇痛腔镜中心完成麻醉镇静的89950例患儿资料,男53203例,女36747例,年龄≤16岁,ASAⅠ—Ⅳ级。由质控小组对不良事件进行定义和分级,记录呕吐、呼吸和循环相关的不良事件及分级,并分析不良事件的危险因素。结果总不良事件发生率为3.79%(95%CI 3.67%~3.92%),其中呕吐发生率1.37%(95%CI 1.30%~1.45%),呼吸相关不良事件发生率0.94%(95%CI 0.87%~1.00%),循环相关不良事件发生率1.49%(95%CI 1.41%~1.56%)。其中警示不良事件195例,发生率0.22%(95%CI 0.19%~0.25%),未发生死亡和永久性神经功能缺失。镇静前未禁食、ASAⅢ或Ⅳ级、年龄<1岁、气管镜、胃肠镜、口服水合氯醛是呕吐的危险因素;气管镜操作是呼吸相关不良事件的危险因素;右美托咪定滴鼻或静注是循环相关不良事件的危险因素。结论患儿手术室外镇静相关不良事件发生率较低,而警示事件的发生率更低。非禁食、ASAⅢ或Ⅳ级、年龄、气管镜、胃肠镜操作及水合氯醛口服是呕吐发生的危险因素;气管镜操作是呼吸相关不良事件的危险因素;右美托咪定是循环相关不良事件的危险因素。Objective To analyze the incidence,types,grades and risk factors of adverse events related to anesthesia and sedation outside the operating room in children.Methods A total of 89950 children who underwent operation from August 2017 to August 2020 were analyzed,53203 males and 36747 females,aged≤16 years,ASA physical statusⅠ-Ⅳ.Definition and grades of adverse events were carried out by quality control team.The incidence and classification of adverse events related to vomiting,respiration and circulation were recorded and analyzed,and the risk factors of adverse events were analyzed.Results The incidence of total adverse events was 3.79%(95%CI 3.67%-3.92%),the incidence of vomiting was 1.37%(95%CI 1.30%-1.45%),the incidence of respiratory-related adverse events was 0.94%(95%CI 0.87%-1.00%),and the incidence of circulatory-related adverse events was 1.49%(95%CI 1.41%-1.56%).Among them,there were 195 cases with adverse event warning,the incidence rate was 0.22%(95%CI 0.19%-0.25%),and no deaths and patients with permanent neurological deficits were found.No fasting before sedation,ASA physical statusⅢorⅣ,age<1 years,bronchoscopy,gastrointestinal endoscopy and had chloral hydrate were the risk factors of vomiting;tracheoscopic operation was a risk factor for respiratory-related adverse events.The use of dexmedetomidine was a risk factor for circulatory-related adverse events.Conclusion The incidence of adverse events related to outside the operating room anesthesia and sedation in children was lower,and the incidence of cautionary events was even lower.The risk factors for vomiting were non-fasting,ASA physical statusⅢorⅣ,age,tracheoscopy,gastroenteroscopy and oral administration of chloral hydrate.The risk factors for respiratory related adverse events were tracheoscopy;risk factors for circulation-related adverse events were administration of dexmedetomidine.

关 键 词：儿童 手术室外 麻醉 镇静 不良事件 危险因素 

分 类 号：R726.1[医药卫生—儿科]