McCormick Michael E, Sheyn Anthony, Haupert Michael, Folbe Adam J
Department of Otolaryngology and Communication Sciences, Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, United States.
Int J Pediatr Otorhinolaryngol. 2013 Sep;77(9):1575-8. doi: 10.1016/j.ijporl.2013.07.012. Epub 2013 Aug 9.
To examine characteristics of young children with gastroesophageal reflux (GER) who experienced complications within the first 24h after adenotonsillectomy.
Subset analysis of a larger retrospective cohort.
A retrospective chart review was performed at a tertiary care children's hospital. Consecutive records of children 3 years old and younger undergoing adenotonsillectomy (AT) over a 5-year period were reviewed. Children with a clinical history of GER were selected for the study.
993 children were included in the initial analysis, and GER was found to be a significant independent variable predictive of early complications. 81 children with a history of GER were included in this study and 8 (9.9%) were found to have experienced complications within the first 24h. Six of the complications were airway-related; two required re-intubation within the first 24h. All 8 children with complications had symptoms of sleep-disordered breathing and two had documented severe obstructive sleep apnea (AHI 18.6 and 27.2). Seven children had other risk factors for complications after AT. Eighteen (22%) children had a prolonged length of stay (range 2-7 days); additional risk factors were present in these patients as well.
Knowledge of risk factors for complications following adenotonsillectomy is critical for identifying at-risk patients that may warrant closer post-operative observation. GER has been previously identified as a risk factor for complications in young children. Upon closer analysis, young children with GER who have other known risk factors may be at a further increased risk for airway complications and prolonged hospitalization. Parents of these children can be counseled on the post-operative risks and the possibility of a longer hospitalization.
研究在腺样体扁桃体切除术后24小时内出现并发症的胃食管反流（GER）幼儿的特征。
对一个更大的回顾性队列进行亚组分析。
在一家三级儿童专科医院进行回顾性病历审查。回顾了5年间3岁及以下接受腺样体扁桃体切除术（AT）的儿童的连续记录。选择有GER临床病史的儿童进行研究。
993名儿童纳入初始分析，发现GER是早期并发症的一个重要独立预测变量。本研究纳入了81名有GER病史的儿童，其中8名（9.9%）在术后24小时内出现并发症。6例并发症与气道相关；2例在术后24小时内需要重新插管。所有8例有并发症的儿童均有睡眠呼吸障碍症状，2例记录有严重阻塞性睡眠呼吸暂停（呼吸暂停低通气指数分别为18.6和27.2）。7名儿童有腺样体扁桃体切除术后并发症的其他危险因素。18名（22%）儿童住院时间延长（2 - 7天）；这些患者也存在其他危险因素。
了解腺样体扁桃体切除术后并发症的危险因素对于识别可能需要术后密切观察的高危患者至关重要。GER此前已被确定为幼儿并发症的危险因素。经进一步分析，有其他已知危险因素的GER幼儿发生气道并发症和住院时间延长的风险可能会进一步增加。可以向这些儿童的家长咨询术后风险以及住院时间延长的可能性。
