儿童气道异物取出术围术期发生呼吸系统严重并发症的危险因素分析

摘要

Objective To identify the risk factors associated with perioperative respiratory adverse events in children undergoing tracheobronchial foreign body removal. Methods A total of 263 children undergoing tracheobronchial foreign body removal by rigid bronchoscopy were selected and divided into two groups, complication group and non-complication group, according to whether the intraoperative and postoperative (within 24 h) respiratory serious complications occurred. Furthermore, comparisons were performed between two groups in past medical history, rate of preoperative respiratory infection, duration of foreign body retention, types of foreign body, operation time and anesthetic effects. The independent risk factors associated with the occurrence of perioperative respiratory adverse events were analyzed by multivariate logistic regression analysis. Results Of the 263 patients included, 31(11.8%) developed respiratory adverse events. Compared with non-complication group, children in complication group had higher rate of preoperative respiratory infection, longer duration of foreign body retention, longer time of operation and higher rate of poor anesthetic effects, and the differences were signiifcant (P<0.05). The results of multivariate logistic regression analysis indicated that the independent risk factors associated with perioperative respiratory adverse events were poor anesthesia effects (OR=11.07, 95%CI:3.16~38.75), preoperative respiratory infection (OR=2.99, 95%CI:1.04~8.59) and longer time of operation (OR=1.07, 95%CI:1.00~1.14). Conclusions If children who underwent tracheobronchial foreign body removal had poor anesthesia effects, preoperative respiratory infection and long operation time, the occurrence of perioperative respiratory adverse events was likely to be increased, so appropriate preventive measures should be adopted.%目的：探讨儿童气道异物取出术围术期发生呼吸系统严重并发症的相关危险因素。方法入选263例行硬质支气管镜气道异物取出术患儿，根据术中及术后24 h内是否发生呼吸系统严重并发症分为并发症组和非并发症组，并通过比较两组患儿既往史、术前呼吸道感染率、异物存留时间、异物种类、手术时间、麻醉效果等差异，分析儿童气道异物取出术围术期发生呼吸系统严重并发症的独立危险因素。结果入选263例患儿中31例发生呼吸系统严重并发症，发生率为11.8%。单因素分析提示，与未发生并发症的患儿比较，发生呼吸系统严重并发症患儿的术前呼吸道感染率更高，异物存留时间更长，手术时间更长，麻醉效果不佳发生率更高，差异均有统计学意义(P均<0.05)。多因素logistic回归分析显示：麻醉效果不佳(OR=11.07，95%CI：3.16~38.75)、术前有呼吸道感染(OR=2.99，95%CI：1.04~8.59)、手术时间越长(OR=1.07，95%CI：1.00~1.14)是儿童气道异物取出术围手术期发生呼吸系统严重并发症的独立危险因素(P均<0.05)。结论对于麻醉效果不佳、术前合并呼吸道感染、手术时间长的患儿，需警惕气道异物取出术围手术期发生呼吸系统严重并发症，并采取相应预防措施。