Nafiu Olubukola O, Shanks Amy, Abdo Samir, Taylor Emma, Tremper Theodore T
Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109-0048, USA.
Int J Pediatr Otorhinolaryngol. 2013 Feb;77(2):256-61. doi: 10.1016/j.ijporl.2012.11.012. Epub 2012 Dec 4.
The purpose of this investigation was to determine whether there is an association between high body mass index (BMI) in children and the occurrence of early post-tonsillectomy pain (PTP). The hypothesis tested was that high BMI is associated with increased severity of early PTP.
We extracted data on all children aged 3-17 years that underwent adeno-tonsillectomy (T&A) over a 2-year period from our anesthesia clinical information system. Patients were classified into normal or high BMI group and early PTP scores were compared between the groups. Clinically significant (moderate-severe) early PTP was defined as pain score ≥ 4 within the first 15 min of admission to the post-anesthesia care unit (PACU).
Among 462 patients, 35.1% were overweight or obese. The overall incidence of moderate to severe early PTP was 23.6%. All the patients received at least one or more intraoperative opioid (morphine 94.2% and fentanyl 21.9%). Compared to those in the normal BMI group, children with moderate-severe PTP were older, female and more likely to be overweight or obese. Children with high BMI had significantly higher unadjusted odds of having moderate-severe early post-tonsillectomy pain (48.9% vs. 14.1%, OR=7.01, 95% CI=3.9-12.8, p<0.001). After controlling for several clinically relevant covariates, high BMI was the most consistent risk factor for moderate to severe early PTP in this cohort of children.
These results indicate that high BMI in children is associated with increased early PTP. The mechanism(s) underlying this association deserve further elucidation.
本研究的目的是确定儿童高体重指数（BMI）与扁桃体切除术后早期疼痛（PTP）的发生之间是否存在关联。所检验的假设是高BMI与早期PTP严重程度增加有关。
我们从麻醉临床信息系统中提取了在两年内接受腺样体扁桃体切除术（T&A）的所有3至17岁儿童的数据。将患者分为正常或高BMI组，并比较两组之间的早期PTP评分。临床上显著的（中度至重度）早期PTP定义为进入麻醉后护理单元（PACU）后15分钟内疼痛评分≥4。
在462例患者中，35.1%超重或肥胖。中度至重度早期PTP的总体发生率为23.6%。所有患者至少接受了一种或多种术中阿片类药物（吗啡94.2%，芬太尼21.9%）。与正常BMI组相比，中度至重度PTP的儿童年龄更大，为女性，且更有可能超重或肥胖。高BMI儿童发生中度至重度扁桃体切除术后早期疼痛的未调整优势明显更高（48.9%对14.1%，OR = 7.01，95%CI = 3.9 - 12.8，p < 0.001）。在控制了几个临床相关协变量后，高BMI是该队列儿童中度至重度早期PTP最一致的危险因素。
这些结果表明儿童高BMI与早期PTP增加有关。这种关联的潜在机制值得进一步阐明。
