足月儿新生儿期腹部手术后发生低血压的危险因素分析  

Risk Factors of Hypotension in Full-term Infants after Abdominal Surgery

作　　者：孙岚 高铮铮 王小雪[1] 陈惠子 王芳[1] 李立晶[1] 张建敏[1] SUN Lan;GAO Zhengzheng;WANG Xiaoxue(Department of Anesthesiology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院麻醉科,100045

出　　处：《医学研究杂志》2023年第7期161-164,91,共5页Journal of Medical Research

摘　　要：目的探讨足月儿在新生儿期行腹部手术后发生低血压的影响因素。方法回顾性收集2019年1月~2021年12月在首都医科大学附属北京儿童医院行腹部手术治疗的新生儿共169例,通过收集患儿的术前一般情况、肾功能、贫血情况、术中出入量、麻醉等级方式等20项指标,以是否发生术后低血压为因变量,采用多因素Logistic回归模型分析术后低血压发生的影响因素。结果最终共169例患儿纳入本研究,以是否发生术后低血压为因变量进行分组,低血压组45例,非低血压组124例,术后低血压总体发生率为26.6%。单因素Logistic回归分析结果显示,两组患儿体重、高龄产妇、术中发生低血压、术中出血及不同麻醉方式比较,差异有统计学意义(P<0.05)。将5项指标逐步纳入多因素Logistic回归分析,在排除混杂因素的情况下,分析得出术中低血压比值比(odds ratio,OR)值为38.84(95%CI:8.775~171.907,P<0.05);与静吸复合麻醉比较时,单纯吸入麻醉OR值为2.605(95%CI:1.031~6.586,P<0.05)。低血压组患儿的七氟烷呼气末浓度明显高于非低血压组的患儿(2.57%vs 2.81%),差异有统计学意义(P<0.05)。结论术中低血压、单纯吸入麻醉(相比于静吸复合麻醉)是足月儿腹部手术后发生低血压的独立危险因素,术中复合应用瑞芬太尼可减少七氟烷的吸入浓度,使循环更加稳定。Objective To explore the influencing factors of hypotension in full-term infants after abdominal surgery in the neonatal period.Methods A total of 169 neonates who underwent abdominal surgery in Beijing Children′s Hospital,Capital Medical University from January 2019 to December 2021 were retrospectively collected.The 20 indexes including preoperative general condition,renal function,anemia,intraoperative volume,anesthesia grade were collected.With the occurrence of postoperative hypotension as the dependent variable,the influencing factors of postoperative hypotension were analyzed by multivariate Logistic regression model.Results A total of 169 children were included in this study,and they were divided into groups based on the occurrence of postoperative hypotension as a dependent variable,including 45 cases in the hypotension group and 124 cases in the non-hypotension group.The overall incidence of postoperative hypotension was 26.6%.Univariate Logistic regression analysis showed that there were statistically significant differences between the two groups in body weight,advanced maternal age,intraoperative hypotension,intraoperative bleeding and different anesthesia methods.The 5 indicators were gradually included in multivariate Logistic regression analysis.With the exclusion of confounding factors,the odds ratio(OR)value of intraoperative hypotension was 38.84(95%CI:8.775-171.907,P<0.05);and the OR value of inhalation anesthesia compared with intravenous-inhalation anesthesia was 2.605(95%CI:1.031-6.586,P<0.05).The end-expiratory concentration of sevoflurane in the hypotensive group was significantly higher than that in the non-hypotensive group(2.57%vs 2.81%),and the difference was statistically significant(P<0.05).Conclusion Intraoperative hypotension and inhalation anesthesia alone(compared with intravenous-inhalation anesthesia)are independent risk factors for hypotension in term infants after abdominal surgery.The intraoperative combination of remifentanil reduced the inhalation concentration of sevof

关 键 词：足月儿 低血压 危险因素 吸入麻醉 

分 类 号：R72[医药卫生—儿科]