腺样体扁桃体切除术患儿麻醉苏醒期发生喉痉挛的相关因素及干预探讨  

Exploration of factors related to laryngospasm during anesthesia recovery period in children undergoing adenoidectomy and tonsillectomy and intervention strategies

作　　者：汤可香 肖婷 符广丽 杜真 Tang Kexiang;Xiao Ting;Fu Guangli;Du Zhen(Department of Anesthesiology,The Affiliated Children’s Hospital of Xiangya School of Medicine,Central South University(Hunan children’s hospital),Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)麻醉科,长沙410007

出　　处：《临床小儿外科杂志》2024年第9期872-877,共6页Journal of Clinical Pediatric Surgery

基　　金：湖南省卫生健康委科研计划项目(202214044031)。

摘　　要：目的观察腺样体和(或)扁桃体切除术患儿麻醉苏醒期喉痉挛发生情况, 分析引起喉痉挛的原因, 并提出相应的处理策略。方法本研究为回顾性研究, 以湖南省儿童医院耳鼻咽喉头颈外科接受腺样体和(或)扁桃体切除术的1 200例患儿为研究对象。患儿术后带气管导管入麻醉恢复室, 根据拔管后是否发生喉痉挛分为喉痉挛组及无喉痉挛组, 收集两组患儿临床信息, 应用二元Logistic回归分析拔管后喉痉挛的原因, 并制定相应干预措施, 观察干预效果。结果 1 200例患儿中, 麻醉恢复期拔管后发生喉痉挛48例(4%)。多因素分析提示, 年龄<6岁(OR=3.799, 95%CI:1.842~7.836)、仰卧位(OR=3.235, 95%CI:1.418~7.382)、近2周上呼吸道感染(OR=3.543, 95%CI:1.482~8.469)、七氟醚吸入麻醉时间>45 min(OR=3.679, 95%CI:1.248~10.818)是致患儿麻醉苏醒期发生喉痉挛的危险因素(P<0.05), 术前经鼻滴入右美托咪定(OR=0.295, 95%CI:0.128~0.682)、术后留置镇痛泵(OR=0.526, 95%CI:0.348~0.796)是患儿麻醉苏醒期喉痉挛发生的保护因素(P<0.05)结论年龄<6岁、仰卧位、近2周上呼吸道感染、七氟醚吸入麻醉时间>45 min会增加腺样体和(或)扁桃体摘除术患儿麻醉苏醒期喉痉挛的发生风险, 临床上应高度重视, 采用针对性干预措施, 以降低麻醉苏醒期喉痉挛的发生率。Objective To observe the occurrence of laryngospasm during the anesthesia recovery period in children undergoing adenoidectomy and tonsillectomy,analyze the causes of laryngospasm,and propose corresponding management strategies.Methods This retrospective study included 1,200 pediatric patients who underwent adenoidectomy and tonsillectomy in the Department of Otolaryngology-Head and Neck Surgery at Hunan Children’s Hospital.After surgery,patients were transferred to the anesthesia recovery room with an endotracheal tube in place.They were divided into two groups based on whether laryngospasm occurred after extubation:the laryngospasm group and the non-laryngospasm group.Clinical information was collected from both groups.Binary logistic regression was used to analyze the causes of laryngospasm after extubation,and corresponding intervention measures were formulated to observe the effect of these interventions.Results Among the 1,200 pediatric patients,48 cases of laryngospasm occurred after extubation during the anesthesia recovery period,with an incidence rate of 4%.Multivariate analysis indicated that age<6 years(OR=3.799,95%CI:1.842-7.836),supine position(OR=3.235,95%CI:1.418-7.382),recent upper respiratory tract infection within 2 weeks(OR=3.543,95%CI:1.482-8.469),and sevoflurane inhalation anesthesia duration>45 minutes(OR=3.679,95%CI:1.248-10.818)were risk factors for laryngospasm during the anesthesia recovery period in pediatric patients(P<0.05).Preoperative intranasal administration of dexmedetomidine(OR=0.295,95%CI:0.128-0.682)and postoperative placement of an analgesic pump(OR=0.526;95%CI:0.348-0.796)were protective factors against laryngospasm(P<0.05).Conclusions Age<6 years,supine position,recent upper respiratory tract infection with 2 weeks,and sevoflurane inhalation anesthesia duration>45 minutes increase the risk of laryngospasm during the anesthesia recovery period in children undergoing adenoidectomy and tonsillectomy.Clinicians should pay close attention and adopt targeted intervention measu

关 键 词：扁桃体切除术 麻醉 全身 喉痉挛 麻醉后护理 儿童 

分 类 号：R47[医药卫生—护理学]